Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis?

The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme’s working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a ‘GP Myeloma diagnostic tool’ and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.

This is a timely approach to increasing the diagnosis of myeloma. Myeloma is a cancer of bone marrow plasma cells that causes impaired immunity, pathological or fragility bone fractures, kidney damage and anaemia.  In the United Kingdom, it is the second most common blood cancer, with an incidence of 9 per 100,000 per year and a median age at diagnosis of 72.6 years.  Its symptoms are nonspecific, and sometimes the diagnosis is not the first to be considered. In the time that I have been in practice, survival has greatly increased, due to systematic approach to clinical studies and new therapies, including ASCT and increased use of diagnostic techniques.

READ THE ARTICLE – https://onlinelibrary.wiley.com/doi/10.1111/bjh.19224