Patient Characteristics, Treatment Patterns, and Survival Outcomes in Newly Diagnosed Multiple Myeloma: A Single-Center Study from South India
Main Article Content
Abstract
Background: Multiple myeloma (MM) is a malignant plasma cell disorder with significant morbidity and mortality, particularly in aging populations. This study aims to evaluate the demographic, clinical, and prognostic characteristics of MM patients at our institute, assess treatment patterns, and analyze survival outcomes to guide risk-adapted therapeutic strategies.
Methodology: This retrospective observational study was conducted on 255 newly diagnosed MM patients between January 2022 and March 2024. Baseline demographics, clinical features, and biochemical markers were analyzed. Patients were staged according to the Revised International Staging System (R-ISS), and treatment regimens, including autologous stem cell transplantation (ASCT), were documented. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were assessed. Statistical analyses were performed using SPSS software (version 24.0). For comparisons, a p value < 0.05 was considered as statistically significant.
Results: The cohort had a mean age of 55.4 years, with a male predominance (67%). The most common CRAB feature was bone disease. R-ISS stage III disease was seen in 65.1% of patients, with significantly higher relapse rates (80.7%) than stages I (0%) and II (12.2%) (p < 0.001). VRd was the most effective induction regimen, with a relapse rate of 26.7% versus 74.7% for CyBorD (p < 0.001). ASCT significantly reduced relapse rates (9% vs. 62.1%, p < 0.001). Median PFS was 15 months, and survival outcomes favored deeper responses and ASCT.
Conclusion: This study highlights the prognostic impact of R-ISS stage, induction regimens, and ASCT on MM outcomes in the setting of a developing country. VRd-based induction and ASCT improved PFS, emphasizing the need for optimal therapy selection in resource-limited settings.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-e548. https://doi.org/10.1016/S1470-2045(14)70442-5
3. Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, et al. Revised International Staging System for Multiple Myeloma: A Report from the International Myeloma Working Group. J Clin Oncol. 2015; 33:2863–9. https://doi.org/10.1200/JCO.2015.61.2267
4. D’Agostino M, Cairns DA, Lahuerta JJ, Wester R, Bertsch U, Waage A, et al. Second Revision of the International Staging System (R2-ISS) for Overall Survival in Multiple Myeloma: A European Myeloma Network (EMN) Report Within the HARMONY Project. J Clin Oncol. 2022;40:3406–18. https://doi.org/10.1200/jco.21.02614
5. Sonneveld P, Dimopoulos MA, Boccadoro M, et al. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2024;390(4):301-313. https://doi.org/10.1056/NEJMoa2312054
6. Voorhees PM, Sborov DW, Laubach J, et al. Addition of daratumumab to lenalidomide, bortezomib, and dexamethasone for transplantation-eligible patients with newly diagnosed multiple myeloma (GRIFFIN): Final analysis of an open-label, randomised, phase 2 trial. Lancet Haematol. 2023;10(10):e825-e837. https://doi.org/10.1016/S2352-3026(23)00217-X
7. Moreau P, Hulin C, Perrot A, Arnulf B, Belhadj K, Benboubker L, et al. Bortezomib, thalidomide, and dexamethasone with or without daratumumab and followed by daratumumab maintenance or observation in transplant-eligible newly diagnosed multiple myeloma: Long-term follow-up of the CASSIOPEIA randomised controlled phase 3 trial. Lancet Oncol. 2024. https://doi.org/10.1016/s1470-2045(24)00282-1
8. Kaedbey R, Reece D, Venner CP, McCurdy A, Su J, Chu M, et al. Long-term follow-up of outcomes including progression-free survival 2 in patients with transplant-ineligible multiple myeloma in real-world practice: A multi-institutional report from the Canadian Myeloma Research Group (CMRG) database. EJHaem. 2024;5:474–84. https://doi.org/10.1002/jha2.894
9. Leleu X, Hulin C, Lambert J, et al. Isatuximab, lenalidomide, dexamethasone and bortezomib in transplant-ineligible multiple myeloma: The randomized phase 3 BENEFIT trial. Nat Med. 2024. https://doi.org/10.1038/s41591-024-03050-2
10. Kumar SK, Therneau TM, Gertz MA, et al. Clinical course of patients with relapsed multiple myeloma. Mayo Clin Proc. 2004;79(7):867-874. https://doi.org/10.4065/79.7.867
11. Kumar SK, Lee JH, Lahuerta JJ, et al. Risk of progression and survival in multiple myeloma relapsing after therapy with IMiDs and bortezomib: a multicenter international myeloma working group study [published correction appears in Leukemia. 2012 May;26(5):1153. Nari, Hareth [corrected to Nahi, Hareth]]. Leukemia. 2012;26(1):149-157. https://doi.org/10.1038/leu.2011.196
12. Moreau P, Kumar SK, San Miguel J, et al. Treatment of relapsed and refractory multiple myeloma: Recommendations from the International Myeloma Working Group. Lancet Oncol. 2021;22(3):e105-e118. https://doi.org/10.1016/S1470-2045(20)30756-7
13. Yanamandra U, Saini N, Chauhan P, et al. AYA-Myeloma: Real-World, Single-Center Experience Over Last 5 Years. J Adolesc Young Adult Oncol. 2018;7(1):120-124. https://doi.org/10.1089/jayao.2017.0034
14. Jacob LA, Suresh Babu MC, Lakshmaiah KC, et al. Multiple myeloma: Experience of an institute in limited resource setting. Indian J Cancer. 2017;54(1):340-342. https://doi.org/10.4103/ijc.IJC_87_17
15. Yanamandra U, Sharma R, Shankar S, et al. Survival outcomes of newly diagnosed multiple myeloma at a tertiary care center in North India (IMAGe: 001A Study). JCO Glob Oncol. 2021;7:704–715. https://doi.org/10.1200/go.20.00625
16. Gupta R, Kaur G, Kumar L, et al. Nucleic acid based risk assessment and staging for clinical practice in multiple myeloma. Ann Hematol. 2018;97(12):2447-2454. https://doi.org/10.1007/s00277-018-3457-8
17. Kastritis E, Terpos E, Roussou M, et al. Evaluation of the Revised International Staging System in an independent cohort of unselected patients with multiple myeloma. Haematologica. 2017;102(3):593-599. https://doi.org/10.3324/haematol.2016.145078
18. Hussain A, Almenfi HF, Almehdewi AM, Hamza MS, Bhat MS, Vijayashankar NP. Laboratory Features of Newly Diagnosed Multiple Myeloma Patients. Cureus. 2019;11(5):e4716. Published 2019 May 22. https://doi.org/10.7759/cureus.4716