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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\u2010one 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\u00a0days vs. 59\u00a0days) 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 &gt;30\u00a0days from initial hospital consultation to haematology assessment. Participants diagnosed through acute services had poorer performance status (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b70001)\u00a0and higher burden of end organ damage (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b70001) with no difference in the overall length of diagnostic pathway compared to those diagnosed by direct referral (median 59\u00a0days). This suggests that advanced disease in patients presenting through acute services predominantly reflects disease aggression.<\/jats:p>","DOI":"10.1111\/bjh.17044","type":"journal-article","created":{"date-parts":[[2020,8,15]],"date-time":"2020-08-15T09:09:51Z","timestamp":1597482591000},"page":"997-1005","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["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"],"prefix":"10.1111","volume":"192","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0596-8515","authenticated-orcid":false,"given":"Catherine","family":"Atkin","sequence":"first","affiliation":[{"name":"Institute of Inflammation and Ageing University of Birmingham Edgbaston Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulnaz","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Planche","sequence":"additional","affiliation":[{"name":"St George's University Hospitals NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6937-2852","authenticated-orcid":false,"given":"Guy","family":"Pratt","sequence":"additional","affiliation":[{"name":"University Hospitals Birmingham NHS Foundation Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6487-276X","authenticated-orcid":false,"given":"Kwee","family":"Yong","sequence":"additional","affiliation":[{"name":"UCL Cancer Institute University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Wood","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Raynes","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Low","sequence":"additional","affiliation":[{"name":"Eric Low Consulting London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Higgins","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Neal","sequence":"additional","affiliation":[{"name":"Institute of Health Sciences University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Dunn","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T","family":"Drayson","sequence":"additional","affiliation":[{"name":"Institute of Immunology and Immunotherapy University of Birmingham, Edgbaston Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8195-8960","authenticated-orcid":false,"given":"Stella","family":"Bowcock","sequence":"additional","affiliation":[{"name":"Department of Haematological Medicine King\u2019s College Hospital NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"TEAMM Trial Management Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Trial Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,15]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Cancer Research UK.Myeloma statistics: Cancer Research UK; [Cancer Research UK myeloma statistics.]. 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