Diagnostic pathways in multiple myeloma and their relationship to end organ damage: an analysis from the Tackling Early Morbidity and Mortality in Myeloma (TEAMM) trial

Research output: Contribution to journalArticlepeer-review


  • Gulnaz Iqbal
  • Tim Planche
  • Kwee Yong
  • Jill Wood
  • Kerry Raynes
  • Eric Low
  • Helen Higgins
  • Richard D. Neal
  • Janet Dunn
  • Stella Bowcock

External organisations

  • The University of Warwick
  • St George's University Hospitals NHS Trust LondonUK
  • University Hospitals Birmingham NHS Foundation Trust
  • UCL Cancer InstituteUniversity College London LondonUK
  • Eric Low Consulting LondonUK
  • Institute of Health Sciences University of Leeds LeedsUK
  • Department of Haematological Medicine King’s College Hospital NHS Trust London UK


Multiple myeloma is associated with significant early morbidity and mortality, with considerable end organ damage often present at diagnosis. The Tackling EArly Morbidity and Mortality in Multiple Myeloma (TEAMM) trial was used to evaluate routes to diagnosis in patients with myeloma and the relationship between diagnostic pathways, time to diagnosis and disease severity. A total of 915 participants were included in the study. Fifty‐one per cent were diagnosed by direct referral from primary care to haematology; 29% were diagnosed via acute services and 20% were referred via other secondary care specialties. Patients diagnosed via other secondary care specialties had a longer diagnostic interval (median 120 days vs. 59 days) without an increase in features of severe disease, suggesting they had a relatively indolent disease. Marked intrahospital delay suggests possible scope for improvement. A quarter of those diagnosed through acute services reported >30 days from initial hospital consultation to haematology assessment. Participants diagnosed through acute services had poorer performance status (P < 0·0001) and higher burden of end organ damage (P < 0·0001) with no difference in the overall length of diagnostic pathway compared to those diagnosed by direct referral (median 59 days). This suggests that advanced disease in patients presenting through acute services predominantly reflects disease aggression.


Original languageEnglish
JournalBritish Journal of Haematology
Early online date15 Aug 2020
Publication statusE-pub ahead of print - 15 Aug 2020


  • multiple myeloma, diagnostic pathways, diagnostic delay, primary care, time to diagnosis