Abstract
Multiple myeloma (MM) is a clonal proliferation of neoplastic plasma cells producing a monoclonal paraprotein of light and/or heavy chain present in the serum and/or urine. Achieving complete response (CR) is the initial goal of myeloma therapy. The recent therapeutic protocols increase MM CR and survival age. This study aimed to determine the efficacy of the main protocols used in Iraq. A cross-sectional study consecutively included all MM patients between July 2015 and May 2022 at one of the main hematology hospitals in Iraq, the National Hematology Centre, to assess the overall response rate (ORR) which represents ≥very good partial response (VGPR). Of the 52 enrolled patients, the mean (±SD) age was 61.5±11.0 years with a 1.5:1.0 male to female ratio and 30.8% had comorbidities. Two participants (3.8%) died before the end of the study. The presenting features include bone pain and backache (67.3%), followed by a mass and lower limb weakness (1.9% each). The radiological changes were lytic lesions (34.6%) and vertebral wedging (15.4%). The main laboratory features were anemia (69.2%, 10.0±1.5g/dL), IgG kappa paraprotein (51.9 %), and high levels of creatinine (35.3%, 1.4±1.5mg/dL) and calcium (30.8%, 9.5±1.7mg/dL). The available drugs include bortezomib (V), lenalidomide (R), thalidomide (T), cyclophosphamide (C), and dexamethasone (D) were used in triple therapeutic regimens, VRD, VTD, and VCD, with or without autologous stem cell transplantation (ASCT). The outcomes were assessed for each protocol used. Results and Main Outcomes: Among 52 patients, 50 were evaluated at a median follow-up of 60.5 months. The median survival could not be calculated, since 2 patients died due to renal failure. ORR was achieved in 75% of the patients, and partial response (PR) in 11.5%. When outcomes were stratified by treatment regimens, there were statistically significant differences in ORR; the best was observed among VRD-group (p<000.1). Subsequently, 21 (40.4%) patients received ASCT with non-significant differences in ORR from those without transplants (P>0.05). VRD achieved the best antitumor activity in MM, followed by VTD, and VCD was the least. Triple therapeutic regimens effectiveness showed non-significant differences, whether used alone or with ASCT.
Published Version
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