{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:48:47Z","timestamp":1791251327360,"version":"4.1.0"},"reference-count":81,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Multiple myeloma (MM) is a heterogeneous plasma cell malignancy with non-specific symptoms and disease heterogeneity at clinical and biological levels. This non-specific set of symptoms, including bone pain, anemia, renal failure, hypercalcemia, and neuropathy, can mislead diagnosis as chronic or benign conditions, resulting in a delay in diagnosis. Timely identification is paramount to prevent organ damage and reduce morbidity. Methods: In this review, we present an overview of recent literature concerning the factors leading to the delayed diagnosis of MM and the impact of delayed diagnosis. This includes factors relevant to physicians and systems, diagnostic processes, primary healthcare services, and laboratory and imaging data access and interpretation. Other emerging technologies to diagnose NCIs include AI-based decision support systems and biomarker-focused strategies. Findings: Delayed diagnosis can lead to presentation at advanced disease stages associated with life-threatening complications and shorter progression-free survival. Patients are often seen by many physicians before they are referred to hematology. Understanding of clinical red flags for MM in primary care is inadequate. Our findings indicate that limited access to diagnostic tests, inconsistent follow-up of MGUS\/SMM patients, and a lack of interdepartmental coordination delay the diagnostic process. Conclusions: Multimodal tools for early diagnosis of MM. Educational campaigns to raise awareness of the disease, algorithms dedicated to routine care and novel technologies, including AI and big data analytics, and new biomarkers may serve this purpose, as well as genomic approaches to the premalignant MGUS stage.<\/jats:p>","DOI":"10.3390\/diagnostics15131708","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T03:47:26Z","timestamp":1751600846000},"page":"1708","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Challenges, Difficulties, and Delayed Diagnosis of Multiple Myeloma"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5108-381X","authenticated-orcid":false,"given":"Tugba","family":"Zorlu","sequence":"first","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve Apaydin","family":"Kayer","sequence":"additional","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazik","family":"Okumus","sequence":"additional","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9332-663X","authenticated-orcid":false,"given":"Turgay","family":"Ula\u015f","sequence":"additional","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Sinan","family":"Dal","sequence":"additional","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fevzi","family":"Altuntas","sequence":"additional","affiliation":[{"name":"Department of Hematology & Apheresis Unit, Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara 06200, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1002\/ajh.25791","article-title":"Multiple myeloma: 2020 update on diagnosis, risk-stratification and management","volume":"95","author":"Rajkumar","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-024-00529-7","article-title":"Multiple myeloma","volume":"10","author":"Malard","year":"2024","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/NHH.0000000000001249","article-title":"Multiple Myeloma","volume":"42","author":"Vrtis","year":"2024","journal-title":"Home Healthc. Now"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1002\/ajh.27422","article-title":"Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management","volume":"99","author":"Rajkumar","year":"2024","journal-title":"Am. J. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5412","DOI":"10.1182\/blood-2008-12-194241","article-title":"Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: A prospective study","volume":"113","author":"Landgren","year":"2009","journal-title":"Blood"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1056\/NEJMoa054494","article-title":"Prevalence of monoclonal gammopathy of undetermined significance","volume":"354","author":"Kyle","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5418","DOI":"10.1182\/blood-2008-12-195008","article-title":"A monoclonal gammopathy precedes multiple myeloma in most patients","volume":"113","author":"Weiss","year":"2009","journal-title":"Blood"},{"key":"ref_8","first-page":"21","article-title":"Efficacy of four-drug regimens in multiple myeloma: A systematic review","volume":"136","author":"Kumar","year":"2020","journal-title":"Blood"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/S1470-2045(20)30756-7","article-title":"Treatment of relapsed and refractory multiple myeloma: Recommendations from the International Myeloma Working Group","volume":"22","author":"Moreau","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1038\/nrclinonc.2016.122","article-title":"Genomic complexity of multiple myeloma and its clinical implications","volume":"14","author":"Manier","year":"2017","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"f3863","DOI":"10.1136\/bmj.f3863","article-title":"Multiple myeloma","volume":"346","author":"Smith","year":"2013","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e019758","DOI":"10.1136\/bmjopen-2017-019758","article-title":"Quantifying intervals to diagnosis in myeloma: A systematic review and meta-analysis","volume":"8","author":"Koshiaris","year":"2018","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2582","DOI":"10.1056\/NEJMoa070389","article-title":"Clinical course and prognosis of smoldering (asymptomatic) multiple myeloma","volume":"356","author":"Kyle","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"290","DOI":"10.4103\/2278-330X.119916","article-title":"Clinical challenges: Myeloma and concomitant type 2 diabetes","volume":"2","author":"Ali","year":"2013","journal-title":"South Asian J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1200\/JCO.2015.65.0044","article-title":"International Myeloma Working Group Recommendations for the Diagnosis and Management of Myeloma-Related Renal Impairment","volume":"34","author":"Dimopoulos","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"vii121","DOI":"10.1093\/annonc\/mdn444","article-title":"The role of novel drugs in multiple myeloma","volume":"19","author":"Dimopoulos","year":"2008","journal-title":"Ann Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/ejh.13264","article-title":"Understanding mortality in multiple myeloma: Findings of a European retrospective chart review","volume":"103","author":"Mohty","year":"2019","journal-title":"Eur. J. Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/bjh.14513","article-title":"Multiple myeloma: Routes to diagnosis, clinical characteristics and survival\u2014Findings from a UK population-based study","volume":"177","author":"Howell","year":"2017","journal-title":"Br. J. Haematol."},{"key":"ref_19","first-page":"578","article-title":"Smoldering multiple myeloma: Pathophysiologic insights, novel diagnostics, clinical risk models, and treatment strategies","volume":"12","author":"Kazandjian","year":"2014","journal-title":"Clin. Adv. Hematol. Oncol."},{"key":"ref_20","unstructured":"Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., and Lewis, D.R. (2021, April 15). SEER Cancer Statistics Review, 1975\u20132018, Available online: https:\/\/seer.cancer.gov\/csr\/1975_2018\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s11357-022-00698-x","article-title":"Multiple myeloma, a quintessential malignant disease of aging: A geroscience perspective on pathogenesis and treatment","volume":"45","author":"Urban","year":"2023","journal-title":"Geroscience"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1093\/qjmed\/hcm077","article-title":"Multiple myeloma: Causes and consequences of delay in diagnosis","volume":"100","author":"Kariyawasan","year":"2007","journal-title":"QJM"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41408-022-00643-3","article-title":"Extramedullary disease in multiple myeloma: A systematic literature review","volume":"12","author":"Beksac","year":"2022","journal-title":"Blood Cancer J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e052759","DOI":"10.1136\/bmjopen-2021-052759","article-title":"Clinical features and diagnosis of multiple myeloma: A population-based cohort study in primary care","volume":"11","author":"Seesaghur","year":"2021","journal-title":"BMJ Open"},{"key":"ref_25","first-page":"1347","article-title":"Symptoms and diagnostic delay in multiple myeloma","volume":"138","author":"Loberg","year":"2018","journal-title":"Tidsskr. Nor. Legeforening"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e586","DOI":"10.3399\/bjgp18X698357","article-title":"Early detection of multiple myeloma in primary care using blood tests: A case-control study in primary care","volume":"68","author":"Koshiaris","year":"2018","journal-title":"Br. J. Gen. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1188\/21.ONF.151-160","article-title":"A Qualitative Study of the Experiences of Living With Multiple Myeloma","volume":"48","author":"LeBlanc","year":"2021","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.clml.2024.03.004","article-title":"Prevalence and Consequences of a Delayed Diagnosis in Multiple Myeloma: A Single Institution Experience","volume":"24","author":"Mateos","year":"2024","journal-title":"Clin. Lymphoma Myeloma Leuk."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1080\/10428190902741471","article-title":"Diagnostic delay and complications for older adults with multiple myeloma","volume":"50","author":"Friese","year":"2009","journal-title":"Leuk. Lymphoma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3007","DOI":"10.1182\/blood-2021-150848","article-title":"An in Depth Analysis of Factors Contributing to Diagnostic Delay in Myeloma: A Retrospective UK Study of Patients Journey from Primary Care to Specialist Secondary Care","volume":"138","author":"Hossain","year":"2021","journal-title":"Blood"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"360","DOI":"10.3324\/haematol.2013.094409","article-title":"Soft-tissue extramedullary multiple myeloma prognosis is significantly worse in comparison to bone-related extramedullary relapse","volume":"99","author":"Pour","year":"2014","journal-title":"Haematologica"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.annonc.2020.11.014","article-title":"Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Dimopoulos","year":"2021","journal-title":"Ann Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1158\/1055-9965.EPI-07-2649","article-title":"Effect of tissue shipping on plasma cell isolation, viability, and RNA integrity in the context of a centralized good laboratory practice-certified tissue banking facility","volume":"17","author":"Ahmann","year":"2008","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ccr.2013.12.015","article-title":"Widespread genetic heterogeneity in multiple myeloma: Implications for targeted therapy","volume":"25","author":"Lohr","year":"2014","journal-title":"Cancer Cell"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"Multiple myeloma: International Myeloma Working Group guidelines for diagnosis, treatment, and response","volume":"15","author":"Rajkumar","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1038\/bjc.2013.1","article-title":"Measures of promptness of cancer diagnosis in primary care: Secondary analysis of national audit data on patients with 18 common and rarer cancers","volume":"108","author":"Lyratzopoulos","year":"2013","journal-title":"Br. J. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1038\/leu.2013.313","article-title":"Continued improvement in survival in multiple myeloma: Changes in early mortality and outcomes in older patients","volume":"28","author":"Kumar","year":"2014","journal-title":"Leukemia"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1182\/blood-2007-08-108357","article-title":"Immunoglobulin free light chain ratio is an independent risk factor for progression of smoldering (asymptomatic) multiple myeloma","volume":"111","author":"Dispenzieri","year":"2008","journal-title":"Blood"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/S0140-6736(10)60482-5","article-title":"Prevalence and risk of progression of light-chain monoclonal gammopathy of undetermined significance: A retrospective population-based cohort study","volume":"375","author":"Dispenzieri","year":"2010","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e302","DOI":"10.1016\/S1470-2045(19)30309-2","article-title":"International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders","volume":"20","author":"Hillengass","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"7776","DOI":"10.1158\/1078-0432.CCR-11-1791","article-title":"Mapping of chromosome 1p deletions in myeloma identifies FAM46C at 1p12 and CDKN2C at 1p32.3 as being genes in regions associated with adverse survival","volume":"17","author":"Boyd","year":"2011","journal-title":"Clin. Cancer Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41408-019-0263-z","article-title":"Detection and prevalence of monoclonal gammopathy of undetermined significance: A study utilizing mass spectrometry-based monoclonal immunoglobulin rapid accurate mass measurement","volume":"9","author":"Murray","year":"2019","journal-title":"Blood Cancer J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1093\/clinchem\/48.9.1437","article-title":"Serum reference intervals and diagnostic ranges for free kappa and free lambda immunoglobulin light chains: Relative sensitivity for detection of monoclonal light chains","volume":"48","author":"Katzmann","year":"2002","journal-title":"Clin. Chem."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S0140-6736(03)12457-9","article-title":"Serum test for assessment of patients with Bence Jones myeloma","volume":"361","author":"Bradwell","year":"2003","journal-title":"Lancet"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1182\/blood-2014-09-568899","article-title":"Smoldering multiple myeloma","volume":"125","author":"Rajkumar","year":"2015","journal-title":"Blood"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3324\/haematol.10554","article-title":"A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma","volume":"92","author":"Zamagni","year":"2007","journal-title":"Haematologica"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"3489","DOI":"10.1182\/blood-2006-08-040410","article-title":"Genetic abnormalities and survival in multiple myeloma: The experience of the Intergroupe Francophone du My\u00e9lome","volume":"109","author":"Attal","year":"2007","journal-title":"Blood"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1182\/blood-2023-186269","article-title":"The Additional Disease Burden Accompanying a Delayed Diagnosis of Multiple Myeloma: Utilising a Large Real-World Evidence Base","volume":"142","author":"Quinn","year":"2023","journal-title":"Blood"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1182\/blood.V124.21.1320.1320","article-title":"Early Mortality in Multiple Myeloma: Risk Factors and Impact on Population Outcomes","volume":"124","author":"Costa","year":"2014","journal-title":"Blood"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1038\/leu.2008.131","article-title":"Pathogenesis and treatment of renal failure in multiple myeloma","volume":"22","author":"Dimopoulos","year":"2008","journal-title":"Leukemia"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1186\/s13054-023-04766-2","article-title":"Interventions to promote cost-effectiveness in adult intensive care units: Consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study","volume":"27","author":"Kansal","year":"2023","journal-title":"Crit. Care"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Religioni, U., Barrios-Rodr\u00edguez, R., Requena, P., Borowska, M., and Ostrowski, J. (2025). Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life. Medicina, 61.","DOI":"10.3390\/medicina61010153"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4777","DOI":"10.1182\/blood.V128.22.4777.4777","article-title":"A real-world evidence systematic literature review of health-related quality of life, costs and economic evaluations in newly-diagnosed multiple myeloma patients","volume":"128","author":"Yong","year":"2016","journal-title":"Blood"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1038\/bjc.2015.41","article-title":"Cancer detection in primary care: Insights from general practitioners","volume":"112","author":"Green","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.1038\/bjc.2015.47","article-title":"Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation","volume":"112","author":"Lyratzopoulos","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"462","DOI":"10.3399\/bjgp22X720737","article-title":"Diagnosing myeloma in general practice: How might earlier diagnosis be achieved?","volume":"72","author":"Smith","year":"2022","journal-title":"Br. J. Gen. Pract."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.3399\/bjgp15X683545","article-title":"Quantifying the risk of multiple myeloma from symptoms reported in primary care patients: A large case-control study using electronic records","volume":"65","author":"Shephard","year":"2015","journal-title":"Br. J. Gen Pract."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e418","DOI":"10.1200\/EDBK_159009","article-title":"Updated Diagnostic Criteria and Staging System for Multiple Myeloma","volume":"35","author":"Rajkumar","year":"2016","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1038\/s41408-021-00480-w","article-title":"Iceland screens, treats, or prevents multiple myeloma (iStopMM): A population-based screening study for monoclonal gammopathy of undetermined significance and randomized controlled trial of follow-up strategies","volume":"11","author":"Love","year":"2021","journal-title":"Blood Cancer J."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1001\/jamaoncol.2018.2128","article-title":"Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016","volume":"4","author":"Cowan","year":"2018","journal-title":"JAMA Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1053\/j.seminoncol.2016.11.004","article-title":"Multiple myeloma epidemiology and survival: A unique malignancy","volume":"43","author":"Kazandjian","year":"2016","journal-title":"Semin. Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1056\/NEJMoa1300439","article-title":"Lenalidomide plus dexamethasone for high-risk smoldering multiple myeloma","volume":"369","author":"Mateos","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1056\/NEJMoa2409029","article-title":"Daratumumab or Active Monitoring for High-Risk Smoldering Multiple Myeloma","volume":"392","author":"Dimopoulos","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e296","DOI":"10.1038\/bcj.2015.20","article-title":"Improvement in renal function and its impact on survival in patients with newly diagnosed multiple myeloma","volume":"5","author":"Gonsalves","year":"2015","journal-title":"Blood Cancer J."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1038\/leu.2012.237","article-title":"High levels of peripheral blood circulating plasma cells as a specific risk factor for progression of smoldering multiple myeloma","volume":"27","author":"Bianchi","year":"2013","journal-title":"Leukemia"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1182\/blood.2021011670","article-title":"How I approach smoldering multiple myeloma","volume":"140","author":"Vaxman","year":"2022","journal-title":"Blood"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Soliman, A.M., Das, S., and Teoh, S.L. (2021). Next-Generation Biomarkers in Multiple Myeloma: Understanding the Molecular Basis for Potential Use in Diagnosis and Prognosis. Int J Mol Sci., 22.","DOI":"10.3390\/ijms22147470"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1038\/s41467-018-04001-5","article-title":"Whole-exome sequencing of cell-free DNA and circulating tumor cells in multiple myeloma","volume":"9","author":"Manier","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Alipour, E., Pooyan, A., Shomal Zadeh, F., Darbandi, A.D., Bonaffini, P.A., and Chalian, M. (2023). Current Status and Future of Artificial Intelligence in MM Imaging: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13213372"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Allegra, A., Tonacci, A., Sciaccotta, R., Genovese, S., Musolino, C., Pioggia, G., and Gangemi, S. (2022). Machine Learning and Deep Learning Applications in Multiple Myeloma Diagnosis, Prognosis, and Treatment Selection. Cancers, 14.","DOI":"10.3390\/cancers14030606"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1200\/JCO.23.02781","article-title":"Artificial Intelligence Individualized Risk Classifier in Multiple Myeloma","volume":"42","author":"Neri","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/ijlh.13806","article-title":"Routine blood biomarkers for the detection of multiple myeloma using machine learning","volume":"44","author":"Fan","year":"2022","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00330-020-07148-2","article-title":"Challenges and solutions for introducing artificial intelligence (AI) in daily clinical workflow","volume":"31","author":"Kotter","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s11899-010-0047-9","article-title":"Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma","volume":"5","author":"Kyle","year":"2010","journal-title":"Curr. Hematol. Malig. Rep."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"5428","DOI":"10.1158\/1078-0432.CCR-16-0866","article-title":"New Developments in Diagnosis, Prognosis, and Assessment of Response in Multiple Myeloma","volume":"22","author":"Landgren","year":"2016","journal-title":"Clin. Cancer Res."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1158\/0008-5472.CAN-17-3115","article-title":"From MGUS to Multiple Myeloma, a Paradigm for Clonal Evolution of Premalignant Cells","volume":"78","author":"Spaan","year":"2018","journal-title":"Cancer Res."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2997","DOI":"10.1038\/ncomms3997","article-title":"Heterogeneity of genomic evolution and mutational profiles in multiple myeloma","volume":"5","author":"Bolli","year":"2014","journal-title":"Nat. Commun."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Mittelman, M., Israel, A., Oster, H.S., Leshchinsky, M., Ben-Shlomo, Y., Kepten, E., Dolberg, O.J., Balicer, R., and Shaham, G. (2025). Can we identify individuals at risk to develop multiple myeloma? A machine learning-based predictive model. Br. J. Haematol., ahead of print.","DOI":"10.1111\/bjh.20136"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e2300081","DOI":"10.1200\/CCI.23.00081","article-title":"Natural Language Processing\u2013Assisted Classification Models to Confirm Monoclonal Gammopathy of Undetermined Significance and Progression in Veterans\u2019 Electronic Health Records","volume":"7","author":"Wang","year":"2023","journal-title":"JCO Clin. Cancer Inform."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.2217\/bmm-2019-0060","article-title":"Serum DKK1 is correlated with \u03b3 peak of serum electrophoresis in multiple myeloma: A multicenter biomarker study","volume":"13","author":"Hashemi","year":"2019","journal-title":"Biomark. Med."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Gerov, V., Gerova, D., Micheva, I., Nikolova, M., Mihaylova, G., and Galunska, B. (2023). Dynamics of Bone Disease Biomarkers Dickkopf-1 and Sclerostin in Patients with Multiple Myeloma. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134440"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1708\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:04:15Z","timestamp":1760033055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/13\/1708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,4]]},"references-count":81,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15131708"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15131708","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,4]]}}}