Independent prognostic factors predicting survival in multiple myeloma patients post-chemotherapy: a retrospective study.

OBJECTIVE

To identify simple clinical predictors of prognosis in multiple myeloma (MM) after chemotherapy and assess their predictive value.

METHODS

We retrospectively analyzed 164 newly diagnosed MM patients treated with proteasome inhibitor- and/or immunomodulatory drug-based chemotherapy between 2018 and 2024. Baseline data included demographics, DS/ISS stage, haemoglobin (Hb), platelets, albumin, creatinine, calcium, lactate dehydrogenase (LDH), erythrocyte sedimentation rate, and serum β2-microglobulin (β2-MG). Treatment responses after four cycles (CR/VGPR vs ≤PR) and survival outcomes were recorded. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. Cox models identified independent prognostic factors. Landmark 2-year ROC curves evaluated discriminative ability.

RESULTS

After four cycles, 95/164 patients (57.9%) achieved CR/VGPR and 69 (42.1%) ≤PR. During a median follow-up of 31 months, 85 deaths and 112 progression events occurred. Multivariable analysis showed that age >60 years, Hb ≤85 g/L, β2-MG>3.5 mg/L, and ≤PR were independently associated with shorter OS, whereas Hb ≤85 g/L and ≤PR predicted shorter PFS. Two-year AUCs for mortality prediction were 0.601 for age, 0.624 for Hb, 0.647 for β2-MG, and 0.731 for response; for PFS prediction, AUCs were 0.668 for Hb and 0.749 for response, indicating fair but limited standalone discrimination.

CONCLUSION

Advanced age, severe anaemia, elevated β2-MG, and suboptimal early response are simple, readily available predictors of adverse survival in MM. Although their individual discriminative power is modest, these factors may inform pragmatic risk stratification, especially where cytogenetic and MRD testing are unavailable, and could be incorporated into future composite prognostic scores.