Presentation and Outcome of Patients with Multiple Myeloma (MM), Single Centre Experience from Windsor Essex Regional Cancer Centre

Dalia Kashash,1 Eric McArthur,2 Caroline Hamm,3 Rasna Gupta,3 Sindu Kanjeekal,3 Mohammad Jarrar,3 Lisa A Porter,4 John W Hudson,4 Adam Renaud,4 Indryas Woldie3 1Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada; 2London Health Sciences Centre, London, Ontario, Canada; 3Medical Oncology, Windsor Regional Cancer Centre, Windsor, Ontario, Canada; 4University of Windsor, Windsor, Ontario, CanadaCorrespondence: Indryas Woldie, Windsor Regional Cancer Centre, Windsor, Ontario, Canada, Email Indryas.woldie@wrh.on.caIntroduction: Outcomes for patients with multiple myeloma has significantly improved through the years. This is mainly related to the use of novel agents.Methods: This is a retrospective study that reviewed presentation and outcome of 139 patients with multiple myeloma at the Windsor Essex Regional Cancer Centre from Jan. 1, 2015 to Dec. 31, 2019. Median age was 71 years and most patients had higher risk disease (65.5% either R ISS stage II or III). 30% had high risk FISH for myeloma including del.17P, t (4:14), t (14:16) and Gain (1q21). In terms of presentation, 38.8% had anemia (hemoglobin < 100g/L), 18.7% had hypercalcemia, 74.1% had skeletal lytic lesions, 38.8% had pathologic fracture and 17.3% had plasmacytoma.Results: Almost all (92%) of the patients were treated using at least one novel agent (proteasome inhibitor or immunomodulators [ImiDs]). Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) was the most used treatment regimen (48.9%) followed by bortezomib, melphalan and prednisone (BMP) at 28.8% and lenalidomide, dexamethasone (LenDex) at 14.4%. With respect to response to therapy, 51.8% had at least Very good partial response (VGPR), while 9.4% had progressive disease. 33% had autologous stem cell transplant. After a median follow up of 2.4 years, median overall survival was 3.7 years. 2 years overall survival and relapse-free survival were 70% and 83%, respectively.Discussion: Our study showed comparable outcome for patients with multiple myeloma despite older age and higher risk disease. Outcome is expected to improve with the introduction of more novel agents.Keywords: multiple myeloma, proteasome inhibitors, immunomodulators