MM-369 Clinical Diversity of Multiple Myeloma Over Time, From First Presentation to Diagnosis, in Kurdistan Region, Iraq

Abstract

Multiple myeloma (MM) is a malignancy of plasma cells, preceded by asymptomatic, premalignant, monoclonal gammopathy of undetermined significance (MGUS). These cells proliferate and accumulate in the bone marrow and other tissues and tend to destroy local bone tissues and inflict remote pathological effects and organ damage. To determine the clinical diversity of MM at presentation, the time elapsed from first symptoms to diagnosis, and the association of this time lapse with the International Staging System (ISS) for MM. A retrospective observational study was conducted on patients with MM admitted to three hematology-oncology healthcare facilities in the Kurdistan region, Iraq, from October 2010 to December 2019. ISS for MM was used to assess the possible effects of time lapse on patients' clinical outcomes. Study participants included all patients diagnosed with MM from participating centers. Exclusion criteria were patients with MGUS, amyloidosis, or smoldering myeloma. Patients' information was collected from the hospitals' electronic databases. Demographic characteristics, such as age, sex, body mass index (BMI), and residency, and detailed clinical features, including the time elapsed from the first appearance symptoms and signs to diagnosis, were recorded. The mean age was 60.58 ± 11.54 years, and the majority of patients (52.27%) were from the Sulaymaniyah governorate. Most patients had higher than normal BMI (63.63%). Most patients had bone pain (78.98%), and 32.37% presented with ≥2 lytic lesions. Most patients (75.1%) were characterized as stage II and III according to the ISS for MM at the time of diagnosis. Furthermore, the mean length of time lapse from first symptom appearance to diagnosis was 3.01 ± 3.18 month (ranging from 0.25 to 18 months). The length of time lapse was not significantly associated with ISS stage. The clinical features of MM at diagnosis are diverse, mostly nonspecific, and shared with a wide range of clinical conditions. However, patients who present with fatigue, bone pain, renal impairment, pallor, or infective events should arouse the clinical suspicion of MM, and these patients should trigger a myeloma workup.