Early Diagnosis of Multiple Myeloma - Project CRAB of Czech Myeloma Group(CMG)

Introduction: Multiple myeloma is one of the most frequent hematological malignancies. The prognosis of patients has substantially improved due to new treatment options. However, the early diagnosis is still a crucial factor for prognosis. First symptoms of myeloma are different and mostly unspecific - therefore many patients are diagnosed late with serious organ and/or tissue damage. Czech Myeloma Group initiated the program for early diagnosis of MM in 2007. Program (named due to educational reasons„CRAB“) was focused on general practitioners (GPs) and key specialists responsible for recognizing the symptoms related to MM (neurology, orthopedics, nephrology). We present results of the final analysis.

Methods: a/ telephonic survey for healthcare professionals, b/ written information for primary care providers, c/ brochures containing definition of clinical symptoms and recommended diagnostic methods, d/ patient questionnaire, e/ presentations at medical meetings in Czech republic, f/ presentation in non-hematological medical journals, g/ e-learning.

Primary objectives were: 1) decrease risk of late diagnosis ( > 3 month after first symptoms of myeloma) from 50% to 30% , 2) reduction of irreversible deterioration at the time of diagnosis from 20% to <10%. Secondary objectives were: 3) improve knowledge of the first-contact care providers about the initial symptoms of multiple myeloma 4) inform them about diagnostic methods applicable in first-contact care 5) inform them about new treatment modalities and improving prognosis of myeloma patiens.

Planned project duration was 7 years (2007-2013). The first interim analysis was done in 2010.

Results: 76,4% patients was diagnosed < 3 month after first contact with healthcare professionals according to the second analysis in 2013. Probability of early diagnosed patients increased from 53,5% in 2007 to 68,8%, ,i.e. by 29% , in 2013 However, incidence of the osteolytic lesions and renal failure at time of diagnosis remained similar.

Conclusion: The 7-year project leads to the increase of early diagnosis of MM by almost one third. Long-term analysis will show whether better knowledge of medical society about myeloma is transient (just during information campaign) or permanent.

Project was supported by Czech Myeloma Group and Jansen-Cillag.