Analysis of Diagnosis and Treatment Pattern for Newly Diagnosed Multiple Myeloma in China over 20 Years

Background:

Multiple myeloma (MM) is the second most common hematopoietic malignancy. Although the disease remains incurable at present, significant advancements in precise diagnostic techniques and prognostic stratification systems over the past decade have led to substantial evolution in treatment approaches for MM. This study aims to analyze real-world data of NDMM patients in the single center in China over the past two decades, highlighting changes in treatment, response rates, and survival outcomes.

Methods:

From 2003 to June 2023, a total of 3357 patients with MM were treated at the Lymphoma and Myeloma Department of our hospital. After screening, 1622 patients who were initially diagnosed and received regular treatment at our hospital were included in the study. We conducted a retrospective analysis of their clinical characteristics, disease staging, treatment regimens, and outcomes. In this study, high-risk cytogenetic abnormalities (HRCA) were defined as the presence of t(4;14), t(14;16), and del(17p) detected by fluorescence in situ hybridization (FISH).

Results：

From 2003 to June 2023, a total of 1622 MM patients were initially diagnosed and received regular treatment in our hospital. This period was divided into four groups: 2003-2007, 2008-2012, 2013-2017, and 2018-2023, with patient numbers of 64, 185, 470, and 903 respectively. The median age of the patients was 57 years, with a slightly higher number of male (58.3%) compared to female (41.7%). The main M protein subtype was IgG (47.9%), followed by IgA (22.6%) and light-chain type (20.3%). The proportion of patients with HRCAs was 22.4%.

First-line induction therapies were categorized as Cytotoxics-based, IMIDs-based, PIs-based, PIs+IMIDs-based, and CD38-included. With the introduction of new drugs, the proportions of patients receiving PIs+IMIDs-based and CD38-included regimens increased over time, reaching 58.3% and 19.8%, respectively, during 2018-2023. The overall proportion of patients undergoing first-line ASCT was 36.6%.

With the development of treatment regimens, the prognosis of patients has shown remarkable improvements. The proportion of patients achieving deep remission (≥CR) reached 64.3% during 2018-2023. Up to July 2023, the median follow-up time for the cohort was 43.0 months, with median PFS and OS of 38.3 months and 97.1 months, respectively.

Cox regression analysis incorporating patient gender, age, ISS stage, LDH level, presence of HRCA, first-line treatment regimen, and whether first-line transplantation was performed revealed that ISS stage III, HRCA, high LDH levels, use of PI+IMIDs, and transplantation were independent prognostic factors.

Conclusion:

The retrospective analysis reveals substantial progress in the treatment and survival of NDMM in China over the past two decades, providing valuable insights into the evolving landscape of multiple myeloma treatment in China. Continued advancements in therapy strategies are essential in further improving outcomes for MM patients in the future.

No relevant conflicts of interest to declare.