Treatment outcome of newly diagnosed multiple myeloma patients: A retrospective analysis in a resource-limited setting

Abstract

Multiple myeloma is the third most common hematologic malignancy in Malaysia. The introduction of novel agents over the past decades has improved patient outcome and survival substantially. The usage of novel agents can be financially taxing, and hence resources limit its use. This study aims to report on the real-world treatment outcome when resources are limited. This is a retrospective study on newly diagnosed multiple myeloma (NDMM) patients diagnosed between 1 January 2008 and 31 December 2018 in a single academic center. Patients demographic and type of treatment were included for analysis of progression free survival and overall survival. Ninety-eight NDMM patients with a median age of 63.5 (ranged from 38 to 87 years old) were included. Half of the total patients received bortezomib-containing regimens while 40.8% received thalidomide-containing regimens, and remaining 9.2% had other agents as induction. Forty-seven patients (48.0%) achieved very good partial response (VGPR) or complete remission (CR), while remaining 51 patients (52.0%) have achieved partial response (PR) at best during induction therapy. Bortezomib use was associated with significantly deeper (p=0.001) and more rapid response (p=0.005) compared to other agents. Five-year OS and PFS were 45.3% and 18.4%, respectively. Triplet regimen, best initial response and upfront ASCT were significantly associated with better PFS. In conclusion, deep response significantly affects PFS and OS in NDMM patients. Thus, one of the goals of treatment is to ensure earlier and deeper response by including bortezomib as part of triplet combination in upfront therapy, followed by ASCT for those who are fit. This is feasible in a resource limited country such as Malaysia, especially there is a cheaper generic formulation.