Investigation of early mortality in the patients with newly diagnosed multiple myeloma: insights from a real-world cohort using J-CHAEGE-MM database.

Although novel therapeutic agents, including proteasome inhibitors, immunomodulatory drugs, and anti-CD38 monoclonal antibodies, have markedly improved outcomes in multiple myeloma (MM), the disease remains incurable and is associated with various causes of death. However, comprehensive analyses of mortality patterns, particularly early mortality, are still limited. In this study, we focused on patients who died within one year of treatment initiation (1-year group), based on data from the J-CHARGE-MM database showing that 146 out of 461 total deaths (31.7%) occurred within the first year. The most common cause of death was disease progression (43.2%), followed by infection (primarily pneumonia and sepsis), which frequently occurred within the first few months of induction therapy. Cardiac-associated events, such as heart failure and cardiac amyloidosis (including suspected cases), accounted for 14.4% of deaths, and sudden death for 7.5%. Multivariate analysis revealed that early mortality was significantly associated with age ≥ 65 years, elevated serum lactate dehydrogenase (LDH), elevated serum C-reactive protein (CRP), and poor performance status (PS ≥ 3), compared with later deaths. These findings support that early mortality in MM may be reduced through comprehensive cardiac evaluation and proactive infection prevention strategies, particularly in elderly patients with elevated CRP, elevated LDH, or poor PS.