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Normal hemoglobin, inflammatory marker combination can rule out multiple myeloma

A combination of normal inflammatory markers, such as plasma viscosity and erythrocyte sedimentation rate, and a normal hemoglobin rating was a “simple rule-out approach” for patients in the U.K. being tested for multiple myeloma in primary care, according to findings recently published in the British Journal of General Practice.

“Patients with myeloma have the longest intervals from initial symptom reporting to diagnosis of all common cancers, with the most consultations in primary care before referral,” Constantinos Koshiaris, MSc, a statistician at the Nuffield Department of Primary Care Health Sciences, University of Oxford in the U.K., and colleagues wrote. “Longer diagnostic intervals in myeloma are associated with more advanced disease stages and more complications at diagnosis.”

Researchers analyzed symptom prevalence and blood tests in 2,703 patients with myeloma in the 5 years leading up to their diagnosis and compared them with those in 12,157 patients without myeloma.

Koshiaris and colleagues found that in the patients with myeloma, raised plasma viscosity had a useful likelihood ratio of 2 (95% CI, 1.7-2.3). The erythrocyte sedimentation rate had a useful likelihood ratio of 1.9 (95% CI, 1.7-2), and the C-reactive protein useful likelihood ratio was 1.2 (95% CI, 1.1-1.4). The test combination with the lowest likelihood ratio for developing myeloma was all normal hemoglobin with calcium and plasma viscosity.

Although the American Cancer Society recently called multiple myeloma a “relatively rare” cancer, the Global Burden of Disease study found that the incidence of the disease is rising worldwide and suggested a need to “improve access to diagnosis” and to explore the etiological determinants of myeloma.

Despite the increased prevalence and call to action, Koshiaris said in an interview not all patients need to undergo the tests used in the current study.

“We do not recommend their use on everyone. These test combinations should be ordered on patients who present with symptoms such as back pain, rib pain, chest pain or repeated infection to determine whether they should be examined further for myeloma or if it can be excluded,” he told Healio Family Medicine.

“Abnormalities in any of these tests should result in urgent serum/urine electrophoresis,” Koshiaris added. – by Janel Miller

References:

American Cancer Society. “Key Statistics About Multiple Myeloma.” https://www.cancer.org/cancer/multiple-myeloma/about/key-statistics.html. Accessed Sept. 19, 2018.

Cowan AJ, et al. JAMA Oncology. 2018; doi:10.1001/jamaoncol.2018.2128.

Disclosures: The authors report no relevant financial disclosures.