Background: Multiple myeloma (MM) is a clonal proliferation of malignant plasma cells that results in the production of a monoclonal paraprotein with a light or heavy chain that is seen in the urine and/or serum. The ultimate goal of the MM therapy is the achievement of complete response (CR). The aim of this study is to evaluate the efficacy of the commonly used therapeutic protocols of MM utilized at the National Center of Hematology in Baghdad, Iraq.
Materials and Methods: Fifty-two patients with MM were enrolled consecutively for a cross-sectional study between July 2015 and May 2022 at one of Iraq’s major hematology institutions, the National Center of Hematology, Mustansiriyah University. The enrolled patients were evaluated for the overall response rate (ORR), which constitutes CR, very good partial response, and partial response, in comparison to non-response (NR), which constitutes stable disease and progressive disease. Responses to the main MM triple therapeutic regimens used in Iraq, VCD, VRD, and VTD, were evaluated. These regimens are composed of cyclophosphamide (C), bortezomib (V), thalidomide (T), lenalidomide (R), and dexamethasone (D). According to its availability, subsequent autologous stem cell transplantation (ASCT) was performed for some patients.
Results: Of the 52 enrolled patients, 50 (96.2%) were assessed at a median follow-up time of 60.5 months. The mean ± SD age of the enrolled patients was 61.5 ± 11.0 years, and the male-to-female ratio was 3:2. However, two patients (3.8%) died before the end of the follow-up. The most common features the patients presented with were bone pain and/or backache in 67.3% of the patients, followed by lower limb weakness and mass (1.9% each). The radiological changes include osteolytic lesions in 34.6% and vertebral wedging in 15.4% of the patients. The most frequent laboratory findings were anemia (69.2%), with hemoglobin levels of 10.0 ± 1.5g/dL, detection of IgG-kappa paraprotein (51.9 %), and high levels of serum calcium in 23.1% (11.7 ± 1.1mg/dL) and serum creatinine in 21.2% (3.3 ± 1.5mg/dL) of the patients. ORR was 88.5%, while NR was reported in 11.5% of the patients. The outcomes were stratified according to the treatment used. It was found that ORR showed statistically significant differences and the VRD group demonstrated the best (P < 000.1). Twenty-one (40.4%) patients underwent subsequent ASCT, and the ORR showed non-significant differences compared to that when patients did not undergo transplantation (P > 0.05).
Conclusions: In this study, VRD was the most effective protocol with a better ORR. In addition, the age of the patients presenting with MM in Iraq was less than in western countries. Also, most of the patients were presented with bone lesions, and IgG was the predominant type of myeloma paraproteins.
