Presenting Signs of Multiple Myeloma and the Effect of Diagnostic Delay on the Prognosis

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Figure 1.
Flow chart for the calculation of time to diagnosis (TTD). ICR, Israel cancer registry; MM, multiple myeloma.
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Figure 2.
Overall survival according to time to diagnosis.

Table 1.

Durie-Salmon Stage, International Staging System Stage, and Survival Status According to Time to Diagnosis in Multiple Myeloma Cases

DSS, Durie-Salmon stage; ISS, international staging system; SD, standard deviation; TTD, time to diagnosis.

Table 2.

Chief Complaint among 110 Cases with Multiple Myeloma, within the 2 Years before Diagnosis

Main complaint	Patients with the Symptom (at Least 1 Visit), n (%)	Visits related to the Symptom, mean ± SD
Pain complaint
Back pain	64 (58)	3.0 ± 5.4
Cervical spine pain	33 (30)	0.8 ± 1.7
Musculoskeletal pain	65 (59)	2.6 ± 3.8
Nonspecific pain	37 (34)	1.0 ± 3.2
>1 Pain complaint	25 (23)	0.6 ± 1.4
No pain complaint	14 (13)
Infections
Viral infection	61 (56)	2.1 ± 2.7
Bacterial infection	52 (48)	1.3 ± 2.3
Weight loss	10 (9)	0.1 ± 0.46
Fatigue	27 (25)	0.5 ± 1.3
Other^*	36 (33)	0.7 ± 1.4
Abnormal laboratory test^{^†}	35 (32)	0.8 ± 2.2

↵* “Other” includes peripheral edema, constipation, pre-syncope, syncope, and dizziness.
↵† Patient's complaint was of an abnormal blood test.
SD, standard deviation.

Table 3.

Abnormal Blood Tests in the 2-Year Period before the Diagnosis of Multiple Myeloma among 110 Cases

Test	Patients Tested, n	Patients with Abnormal Results, n (%)^*
Hemoglobin	100	68 (68)
Calcium	85	14 (17)
ESR	68	56 (82)
Albumin	80	11 (14)
Total protein	81	32 (39)
Creatinine	92	26 (28)
Proteinuria	76	31 (41)
Uric acid	83	30 (36)

↵* Abnormal results: hemoglobin <12.3 for women and <13.5 g/dL for men; calcium >10.2 mg/dL; erythrocyte sedimentation rate (ESR) >20 in the first hour; albumin <3.4 g/dL; total protein >8.7 g/dL; creatinine >1.1 for women and >1.2 mg/dL for men; proteinuria >10 mg/dL; uric acid >5.7 mg/dL.
ESR, erythrocyte sedimentation rate.

Table 4.

Comparison of Clinical Features of 79 Multiple Myeloma Cases and 79 Age-, Sex-, and Regionally Matched Controls

	Visits, Mean ± SD		P Value
	Patients	Controls	P Value
Main complaint
Back pain	2.7 ± 4.1	2.9 ± 4.4	.81
Nonspecific pain	1.2 ± 3.8	0.7 ± 1.4	.28
>1 Pain complaint	0.6 ± 1.4	0.3 ± 0.8	.11
Viral infection	1.4 ± 1.9	1.6 ± 2.4	.59
Bacterial infection	1.2 ± 2.4	1.3 ± 1.8	.81
Weight loss/fatigue	0.7 ± 1.5	0.1 ± 0.4	.001
Other nonspecific complaints	0.7 ± 1.4	0.4 ± 0.5	.05
Abnormal laboratory test^*	0.7 ± 1.4	0.1 ± 0.6	.001

↵* Anemia = hemoglobin <12.3 g/dL for women and <13.5 g/dL for men; elevated erythrocyte sedimentation rate (ESR) >20 in the first hour; renal failure = creatinine >1.1 mg/dL for women and >1.2 mg/dL for men; proteinuria = >10 mg/dL; hypercalcemia = calcium >10.2 mg/dL; high total protein = >8.7 g/dL; hypoalbuminemia = albumin <3.4 g/dL; hyperuricemia = uric acid >5.7 mg/dL.
ESR, erythrocyte sedimentation rate; SD, standard deviation.