Retrospective analysis of patients who diagnosis with multiple myeloma at adult Dicle University Adult Hematology Clinic between 2010-2019

Purpose: MM; is defined as plasma cell dyscrasias characterized by clonal plasma cell infiltration and monoclonal immunoglobulin production of bone marrow and causing end organ damage associated with lytic lesion, renal insufficiency, hypercalcemia and anemia. In this study, we aimed to investigate the demographic characteristics, laboratory parameters, treatments, treatment responses and compare the literature with the data of patients diagnosed with MM in our clinic. Method: In this study, the data of 272 patients diagnosed as MM in the internal medicine hematology clinic of Dicle University Medical Faculty between January 1, 2010 and January 31, 2019 were analyzed retrospectively. The general characteristics, laboratory values, treatment options, treatment responses, mean survival and mortality causes of the patients included in the study were investigated. Results: 159 (58.5%) of the patients were male and 113 (41.5%) were female. The mean age was 62.1 ± 11.69 years and the male female ratio was 1.4. 13 (4.8%) patients were under 40 years of age, 125 (45.9%) patients were over 65 years of age. The patients follow-up period was 26 months, the mean survival time was 52 (standard deviation: 3.2; CI: 45.7-58.3) months, and the median survival time was 45 (standard deviation: 5.1; CI: 35-55) months. Myeloma defining events were found bone lesion 63%, anemia 44.5%, renal failure 19.9% and hypercalcemia 16.9%. Bone involvement was most commonly observed in vertebral bones with a rate of 40.8%; the other involved bones formed limbs, pelvis and ribs, respectively. The lowest median survival time was 35 (standard deviation: 4.6; CI: 26.1-451.1) months in patients with anemia. In subtype analysis, 124 (45.6%) patients were IgG, 50 (18.4%) were IgA, 59 (21.7%) were light chain, 21 (7.7%) were plasmacytoma, 4 (1.5%) were IgM, 3 (1.1%) were plasma cell leukemia and 11 (4%) were nonsecretory myeloma. Renal involvement was most commonly detected in light chain myeloma.(p=0,004). Treatment was performed as a step. The most commonly used regimen at first step was VCD with 47.1% and VAD with 29.8%. The most commonly used regimens in the second step were VCD and LD with 46.3% and 46.9%. In the third step, the most commonly used regimen was LD with 61.2% and followed by new generation proteosome inhibitors, carfilzomib, ixsazomib and new generation IMID with pomalidomid (22.5%). Treatment response rate was 43.3% in the first step, 64.4% in the second step and 51.6% in the third step. AHSCT was performed in 77 patients. The mean survival tıme in patients undergoing AHSCT is 68 months. The mean survival tıme was 42 months in patients without AHSCT (p <0,001). VAD response rate was 22.2%, VCD response rate was 58.5%, new generation IMID and proteosome inhibitors, pomalidomide, carfilzomib and xsazomib, were 71.4% and in patients who had undergone AHSCT is 80.5%. The most common causes of mortality were infection (55%), thromboembolic events (22%), hemorrhagic complications and comorbid conditions (22%). Conclusion: MM is mainly advanced age disease and is more common in men. In our study, in accordance with the literature, most of our patients were elderly patients and male predominance was in the foreground. The rates of myeloma-defining events, treatment response rates, survival times, survival times in patients who underwent AHSCT and mortality reasons were similar with the literature data. We see that treatment response rates and mean survival times increase with the presence of new agents, and that more studies are needed to achieve more successful results, that the most effective treatment method is AHSCT, and that prophylactically appropriate patients should be given anticoagulant, antithrombotic, antibiotic, antifungal, and antifungal treatments to reduce mortality. Key words: Multple myelom, AHSCT, immunoglobulin, plasma cell