International Staging System Status and Trend of Relapse in Multiple Myeloma Cases in a Tertiary Level Health Care

Multiple myeloma (MM) is a haematological neoplasm of mature B-cell lineage origin. It is characterized by abnormal clonal proliferation of plasma cells and presence of monoclonal protein in serum and / or urine. This study was conducted to observe the International Staging System (ISS) status and trends of relapse. This descriptive cross-sectional study was performed in the department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2019 to July 2020 among 81 purposively selected Multiple myeloma patients. Principal investigator collected data using Case Record Form (CRF) after obtaining informed consent. Relevant ethical issues and data quality assurance were taken into consideration. Data were analyzed with Statistical Package for Social Sciences (SPSS), Version 25.0. Chi square test, Fisher's exact test and Chi square test with Yate's correction were carried out as appropriate with five percent level of significance for assessing statistical association. Mean age of patients with Multiple myeloma was 58.9±12.0 years. Male female ratio was nearly 2:1. ISS stage III was in 59.4 percent cases, lytic lesions were present in 75.0% and mean Bone Marrow Plasma Cell (BMPC) percentage was 62.1±24.9 percent. Immuno-Fixation Electrophoresis (IFE) revealed IgG Kappa (47.3%), IgG Lambda (25.5%) IgA Lambda (10.9%), IgA Kappa (7.2%) and Free Light Chain (9.1%). Kappa lambda ratio was 60.7:39.3. Free Light Chain (FLC) ratio ≥100 was in 29.0 percent cases. Four-fifths 65(80.2%) cases were de novo, while nearly one-fifth 16(19.8%) were the relapsed cases. Mean duration to become relapsed or refractory was 37.6±19.4 months. Significant association was observed among advanced ISS staging with refractory or relapse. Erythrocyte sedimentation rate in 1st hour (ESR), FLC ratio, FISH cytogenetics, Immunofixation electrophoresis (IFE) and treatment protocol was not found to have statistical association with relapse or refractoriness (p>0.05). A significant number of cases are de novo; while nearly one in five are relapsed one. Mean duration for refractoriness is 37.6±19.4 months. Patients are treated with established chemotherapeutic protocols. About one-fifth of patients developed refractoriness with progression of time.