Improved Myeloma Diagnosis Based on Blood Count Components

A team of British researchers has found which blood tests could be useful for suggesting or excluding a diagnosis of myeloma.

Multiple myeloma is a hematological cancer characterized by numerous non-specific symptoms leading to diagnostic delay in a large proportion of patients. Symptoms can occur up to two years before diagnosis in other cancers, but little is known about the timing of symptoms and abnormal blood test results before diagnosis in myeloma.

Investigators at the University of Exeter (United Kingdom) and the University of Oxford (United Kingdom) sought to identify the best inflammatory markers for initial investigation of possible myeloma, useful blood tests for ruling out symptomatic myeloma, and how to distinguish early and late features of the disease.

For this study, they analyzed symptom prevalence and blood tests up to five years before diagnosis in 2703 cases and 12,157 matched controls. Likelihood ratios (LR) were used to classify tests or their combinations as useful rule-in or rule-out tests.

Results suggested that the best inflammatory markers to supplement symptoms of myeloma were plasma viscosity (PV) and erythrocyte sedimentation rate (ESR), while C-reactive protein (CRP) was unhelpful. In addition, the combination of normal hemoglobin and PV could be used to rule out the disease on patients currently being tested in primary care. The results further demonstrated that the full blood count components and especially low hemoglobin were among the earliest presentations of the disease, which may allow the diagnosis to be expedited.

Senior author Dr. William Hamilton, professor of primary care diagnostics at the University of Exeter, said, "Ordinarily a GP will see a patient with myeloma every five years - and early diagnosis matters. More timely treatment could significantly improve survival rates for this disease. We report a simple way a GP can check patients presenting symptoms such as back, rib, and chest pain, or recurrent chest infections, and determine whether they have myeloma or not."

The study was published in the August 13, 2018, online edition of the British Journal of General Practice.

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University of Exeter
University of Oxford