I came across a table recently that reported on the most common symptoms that multiple myeloma patients experience at the time of diagnosis. I thought it might be useful to have here in the forum when questions come in about possible cases of multiple myeloma.
Here are the data. The percents are the percent of newly diagnosed (symptomatic) multiple myeloma patients who have the particular symptom:
Anemia (<12 g/100 ml) - 72%
Bone lesions (lytic lesions, pathologic fractures or severe osteopenia) - 80%
Renal failure (serum creatinine greater than or equal to 2 mg/100 ml) - 19%
Hypercalcemia (greater than or equal to 11 mg/100 ml) - 13%
Monoclonal protein on serum protein electrophoresis - 82%
Monoclonal protein on serum protein immunofixation - 93%
Monoclonal protein on serum plus urine protein immunofixation (or serum immunofixation plus serum free light chain assay) - 97%
Also, there is this information, which may be helpful as well
Type of monoclonal protein found at time of diagnosis
IgG - 52%
IgA - 21%
Light chain only (i.e., no heavy chain such as IgG or IgA) - 16%
These data are from this table, which is from this article:
RA Kyle and SV Rajkumar, "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma," Leukemia, 2009 (full text of article)
These data were compiled for patients diagnosed under the previous diagnostic criteria for multiple myeloma, not the new criteria published last year. So the percentage of patients with different symptoms will change moving forward as the new criteria start to be used more regularly.
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Re: Most common symptoms at multiple myeloma diagnosis
Thanks Terry - Good information. It is kind of nice to know where we stack up with our fellow myeloma patients. Also, these are some benchmarks that we can use to explain to our family members who seem totally confused by this disease.
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PattyB - Name: PattyB
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: July 2014
- Age at diagnosis: 64
Re: Most common symptoms at multiple myeloma diagnosis
I couldn't help but notice that a combination of heavy and light chains is not listed. Does this mean that a diagnosis of IgG kappa myeloma is exceptionally rare? Or have I just missed something here?
Thanks and Aloha
Daniel
Thanks and Aloha
Daniel
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DanielR - Name: Daniel Riebow
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 12/2012
- Age at diagnosis: 59
Re: Most common symptoms at multiple myeloma diagnosis
Hi Daniel,
Someone with IgG myeloma could have either IgG kappa or IgG lambda. It is technically possible, I believe, for someone to have an elevated level of one immunoglobulin (e.g., IgG) at diagnosis, without also having elevated kappa or lambda light chains. But it is very, very rare. Usually, when an immunoglobulin (IgA or IgG in most cases) is elevated at diagnosis, one of the light chain levels is also elevated.
So the 52% of patients who had IgG myeloma at diagnosis had either IgG kappa or IgG lambda. The authors of the study just did not further split the IgG patients into those two subcategories.
The same is true for the 21% of patients with IgA myeloma. That 21% includes IgA kappa and IgA lambda patients.
Good question. Thanks.
Someone with IgG myeloma could have either IgG kappa or IgG lambda. It is technically possible, I believe, for someone to have an elevated level of one immunoglobulin (e.g., IgG) at diagnosis, without also having elevated kappa or lambda light chains. But it is very, very rare. Usually, when an immunoglobulin (IgA or IgG in most cases) is elevated at diagnosis, one of the light chain levels is also elevated.
So the 52% of patients who had IgG myeloma at diagnosis had either IgG kappa or IgG lambda. The authors of the study just did not further split the IgG patients into those two subcategories.
The same is true for the 21% of patients with IgA myeloma. That 21% includes IgA kappa and IgA lambda patients.
Good question. Thanks.
Re: Most common symptoms at multiple myeloma diagnosis
There's a study that was published recently with some additional results relevant to this topic.
The authors of the study find that people who eventually are diagnosed with multiple myeloma most often have back pain accompanied by fatigue or weight loss prior to their diagnosis. Low hemoglobin levels, an elevated ESR, and an elevated creatinine level are the most common abnormal lab results.
Here's the abstract for the study:
Background: Presenting symptoms of multiple myeloma are vague and nonspecific. Early detection poses a diagnostic challenge in primary care. We assessed whether clinical and laboratory data could provide early clues to multiple myeloma diagnosis and whether time to detection affects survival.
Methods: A retrospective population-based study, including 110 men and women diagnosed with multiple myeloma between 2002 and 2011, and matched cancer-free controls presenting with back pain. Clinical and laboratory data were extracted from medical records for the 2-year period prior to diagnosis of multiple myeloma / back pain complaint.
Results: During the two years prior to diagnosis 64 (58%) of multiple myeloma patients complained of back pain, and 37 (34%) suffered from fatigue or weight loss. Case-control comparisons did not reveal any significant differences in the number of pain complaints or infections in the two-year prediagnostic period. However, fatigue or weight loss, anemia, elevated ESR and creatinine (p < 0.001 for all) occurred more frequently in multiple myeloma patients than controls and were confirmed as independent predictors in multivariated analysis. TTD did not impact stage at diagnosis, survival, or mortality.
Conclusions: Back pain accompanied by fatigue, weight loss or abnormal lab results should raise a “red flag” warning of multiple myeloma. Nonetheless, we did not find evidence that TTD influences the initial stage or the prognosis of multiple myeloma.
Here's the reference:
Goldschmidt, N, et al, "Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis", Journal of the American Board of Family Medicine, Nov-Dec 2016 (full text of article)
The authors of the study find that people who eventually are diagnosed with multiple myeloma most often have back pain accompanied by fatigue or weight loss prior to their diagnosis. Low hemoglobin levels, an elevated ESR, and an elevated creatinine level are the most common abnormal lab results.
Here's the abstract for the study:
Background: Presenting symptoms of multiple myeloma are vague and nonspecific. Early detection poses a diagnostic challenge in primary care. We assessed whether clinical and laboratory data could provide early clues to multiple myeloma diagnosis and whether time to detection affects survival.
Methods: A retrospective population-based study, including 110 men and women diagnosed with multiple myeloma between 2002 and 2011, and matched cancer-free controls presenting with back pain. Clinical and laboratory data were extracted from medical records for the 2-year period prior to diagnosis of multiple myeloma / back pain complaint.
Results: During the two years prior to diagnosis 64 (58%) of multiple myeloma patients complained of back pain, and 37 (34%) suffered from fatigue or weight loss. Case-control comparisons did not reveal any significant differences in the number of pain complaints or infections in the two-year prediagnostic period. However, fatigue or weight loss, anemia, elevated ESR and creatinine (p < 0.001 for all) occurred more frequently in multiple myeloma patients than controls and were confirmed as independent predictors in multivariated analysis. TTD did not impact stage at diagnosis, survival, or mortality.
Conclusions: Back pain accompanied by fatigue, weight loss or abnormal lab results should raise a “red flag” warning of multiple myeloma. Nonetheless, we did not find evidence that TTD influences the initial stage or the prognosis of multiple myeloma.
Here's the reference:
Goldschmidt, N, et al, "Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis", Journal of the American Board of Family Medicine, Nov-Dec 2016 (full text of article)
Re: Most common symptoms at multiple myeloma diagnosis
Thanks for starting this thread, Terry.
Some recent questions here in the forum got me looking for additional information about what symptoms myeloma patients have had at diagnosis. I found this paper,
Howell, DA, "Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: a report from the Haematological Malignancy Research Network," BMC Blood Disorders, Oct 2013 (full text of article)
which has a useful figure (#2) that lets you list out which symptoms most frequently occurred in multiple myeloma patients prior to their diagnosis. Those symptoms, listed from "most frequently" to "least frequent", were:
1. Pain (48%)
2. Tiredness (21%)
3. Joint problems/fractures (13%)
4. Shortness of breath/cough (8%)
5. Infections (4%)
6. Gastrointestinal (3%)
7. Other (2%)
(The percentages are my estimates based on eyeballing the graph.)
These results suggest that bone-related problems and anemia are by far the most common symptoms leading up to a myeloma diagnosis.
Bone-related problems probably account for most cases of items #1 (pain) and #3 (joint problems/fractures) in the above list, which were symptoms experienced by 61% of the myeloma patients in the study.
Anemia probably accounts for most cases of items #2 (tiredness) and #4 (shortness of breath/cough) in the list, which were symptoms experienced by 29% of the myeloma patients in the study.
The remaining symptoms were experienced by 10 percent or less of the myeloma patients. So it's really bone-related issues and anemia which probably lead to most myeloma diagnoses precipitated by symptoms (as opposed to being found on routine blood tests or imaging).
Some recent questions here in the forum got me looking for additional information about what symptoms myeloma patients have had at diagnosis. I found this paper,
Howell, DA, "Time-to-diagnosis and symptoms of myeloma, lymphomas and leukaemias: a report from the Haematological Malignancy Research Network," BMC Blood Disorders, Oct 2013 (full text of article)
which has a useful figure (#2) that lets you list out which symptoms most frequently occurred in multiple myeloma patients prior to their diagnosis. Those symptoms, listed from "most frequently" to "least frequent", were:
1. Pain (48%)
2. Tiredness (21%)
3. Joint problems/fractures (13%)
4. Shortness of breath/cough (8%)
5. Infections (4%)
6. Gastrointestinal (3%)
7. Other (2%)
(The percentages are my estimates based on eyeballing the graph.)
These results suggest that bone-related problems and anemia are by far the most common symptoms leading up to a myeloma diagnosis.
Bone-related problems probably account for most cases of items #1 (pain) and #3 (joint problems/fractures) in the above list, which were symptoms experienced by 61% of the myeloma patients in the study.
Anemia probably accounts for most cases of items #2 (tiredness) and #4 (shortness of breath/cough) in the list, which were symptoms experienced by 29% of the myeloma patients in the study.
The remaining symptoms were experienced by 10 percent or less of the myeloma patients. So it's really bone-related issues and anemia which probably lead to most myeloma diagnoses precipitated by symptoms (as opposed to being found on routine blood tests or imaging).
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