Abstract
BACKGROUND: Advances in treatment has improved greatly survival of multiple myeloma in the last two decades, and this improvement has been endorsed by wider use of novel drugs and tandem autologous stem cell transplantation. However, still there were cases died earlier post diagnosis OBJECTIVES: To study the risk factors of early mortality in patients with multiple myeloma In Kurdistan region of Iraq PATIENTS AND METHODS: A 176 cases that were diagnosed with symptomatic multiple myeloma between (January 2012 – July 2019) in cancer centers in Kurdistan region of Iraq. A total of 152 were continued within the study through their recorded sheet. Their data were analysed to determine what are the main risk factors that have an impact on early mortality among our myeloma patients. RESULTS: Among the total of 152 studied patients nine of them (5.9%) died early. The highest proportion (32.2%) of the sample aged 60-69 years, more than half (57.2%) of the them were male. The majority of the patients (80.9%) have been diagnosed during 2016-2019. The incidence of early death was 8.7% among patients who didn’t take the cytotoxic treatment compared with 1.7% of patients who took that treatment, but the difference was not significant (p = 0.089). The early death rate was significantly high (22.2%) among patients who didn’t take the immunomodulatory drugs, versus 2.4% of patients who took the immunomodulatory drugs (p = 0.001). The incidence of early mortality was 9.6% among patients with lactate dehydrogenase of ≥ 250 U/L compared with 0%
Highlights
Multiple myeloma (MM) is characterized by the proliferation of a single clone of plasma cells that produce a monoclonal protein
Data collection was performed by reviewing medical records of the patients that was involved demographic data and laboratory data includinghemoglobin, bone marrow examination, serum albumin, corrected serum calcium,serum creatinine, (LDH) and β2microglobulin (β2M), the performance state of the patients was determined according to the Eastern Cooperative Oncology Group (ECOG) performance score depending on the available data in the patients files
This is the first cohort study to examine the risk factors associated with early mortality in patients newly diagnosed with MM in Kurdistan region Iraq (Erbil, Sulaimaniyah, and Duhok) in which the diagnosis was confirmed by careful evaluation and reviews of all medical records, and complete information on disease description and initial treatment for individual patients was taken
Summary
Multiple myeloma (MM) is characterized by the proliferation of a single clone of plasma cells that produce a monoclonal protein. The excessive production of nephrotoxic monoclonal immunoglobulin can result in renal failure and an increased risk of developing potentially lifethreatening infections due to the lack of functional immunoglobulins.[1] MM represents approximately 10% of hematologic malignancy and 1% of all cancers. It is conventionally considered incurable; accounts for 20% of deaths from hematologic malignancy and 2% of all cancer deaths.[2] There is a slight male predominance. The Mayo clinic estimated that the median survival of myeloma patients is 8 years, and improvements have occurred during early stages of the disease and throughout the disease course.[11]
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