Retrospective Analysis of 345 Multiple Myeloma Cases: An Investigation from 2 Institutions

Multiple myeloma (MM) accounts for a substantial mortality rate among hematological cancers. The prognosis of the disease has been noticeably changed during the past 2 decades. This study reports a retrospective analysis of 345 MM cases from 2 cancer centers. Medical records of 345 MM cases were analyzed in retrospect. Diagnosis of MM was defined in presence of at least 10% plasma cells in bone marrow biopsy and one of the CRAB findings (hypercalcemia, renal failure, anemia and myeloma bone lesions). Survival analysis was performed using Kaplan-Meier method, and the effects of prognostic variables were assessed by Cox proportional hazards model. The mean age of the patients was 61.98 ± 11.44 years. Comparing to Mayo Clinic series, our patients were relatively younger and suffered from more advanced disease. By a median follow up time of 45 months, 1- and 5-year overall survival (OS) rates were 78.0% and 35.6%, respectively. Regarding first progression free survival (PFS1), similar rates of 57.7% and 17.0% were observed respectively. In multivariate analysis, hypercalcemia (corrected serum calcium >11 mg/dL), pancytopenia and elevated serum creatinine (Cr) (>2 mg/dL) were found to be independent prognostic factors affecting OS. Presentation of MM in Iran which is a developing country, was significantly different from developed countries. This finding might be generalized to other developing countries as well. In addition, vincristine-adriamycin-dexamethasone (VAD) therapy was an inferior protocol compared to bortezomib as first and second lines. Furthermore, pancytopenia was observed in about 9% of the patients and was an independent prognosticator of the disease.