When should I consider referring a patient with suspected multiple mye

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient with suspected multiple myeloma to a specialist for further evaluation if they have:

Persistent bone pain, especially back pain, or unexplained fractures combined with laboratory evidence suggestive of myeloma, such as the presence of Bence–Jones protein in urine or abnormal serum protein electrophoresis results indicating a paraprotein .
Laboratory findings including abnormal serum protein electrophoresis, serum immunofixation confirming paraprotein, or abnormal serum-free light-chain assay results that suggest possible myeloma or monoclonal gammopathy of undetermined significance (MGUS) .
Imaging findings suggestive of myeloma-related bone disease or extramedullary plasmacytomas, especially if whole-body MRI, low-dose CT, or FDG PET-CT indicate abnormalities .

Referral should be made using a suspected cancer pathway to ensure timely specialist assessment and diagnosis .

When should I consider referring a patient with suspected multiple myeloma to a specialist for further evaluation?