Survival in patients with multiple myeloma: evaluation of possible associations with bone marrow fibrosis and investigation of factors independently associated with survival

Abstract

Abstract Background Multiple myeloma (MM) is characterized by infiltration of neoplastic plasma cells in the bone marrow. Although many novel agents have been developed in the last decade, MM remains a non-curable disease. The association between bone marrow fibrosis (BMF) and MM survival is unknown, and the considerable changes in patient survival during the last few decades necessitates new studies to examine survival and associated factors in patients with MM. Results A total of 72 patients with MM, 39 (54.17%) males and 33 (45.83%) females, were included in this retrospective study. Fifteen patients did not have BMF, 55 had BMF (grades 1–4); there were no significant differences between these groups in terms of any of the parameters examined. The 5-year overall survival (OS) rate was 56.5 ± 7.4%. Mean OS was 81.54 ± 7.01 months, mean progression-free survival (PFS) after first-line treatment was 14.07 ± 2.54 months, and mean PFS after autologous stem cell transplantation (ASCT) was 25.92 ± 3.66 months. Survival times or mortality risk were not found to be associated with BMF in any of the analyses (HR 1.208, [95% CI 0.408–3.578], p = 0.733). Mortality risk was increased by 8.163-fold in patients with hypercalcemia (HR 8.163, 95% CI 2.413–27.617, p = 0.001), while it was decreased by 0.243-fold in patients with favourable response to first-line treatment (HR 0.243, 95% CI 0.078–0.756, p = 0.015). Younger patients (< 60 years) had a 1.981-fold greater risk of progression after first-line treatment (HR 1.981, 95% CI 1.111–3.532, p = 0.021), while those with hypercalcemia had a 3.160-fold greater risk of progression after ASCT (HR 3.160, 95% CI 1.103–9.052, p = 0.032). Low haemoglobin levels were also associated with increased mortality risk (p = 0.024). Conclusion Although hypercalcemia, unfavourable treatment response, young age and a low haemoglobin level were found to be indicators of poor prognosis in patients with MM, no relationship was found between BMF and survival.

Keywords

• Multiple myeloma
• Bone marrow fibrosis
• Survival
• Prognostic factors
• Survival analysis