Multiple myeloma in Mexico: a retrospective study on long-term survival in a publicly insured cohort

We retrospectively analyzed 293 adults with multiple myeloma treated at a tertiary public center (2002-2024; 65% men; median age 58). Kaplan-Meier for survival estimation and Cox proportional-hazards models for associations. Median follow-up was 2.9 years; 47 (16%) underwent autologous stem-cell transplantation (ASCT). Overall survival (OS) at 3, 5, and 10 years were 84%, 76%, and 60%. ASCT was associated with higher unadjusted 10-year OS (74.1% vs 56.1%; p = 0.007), but was not significant after adjustment (p = 0.20). In multivariable analyses, higher hemoglobin was protective (HR 0.79; 95% CI 0.67-0.92; p = 0.003), and higher lactate dehydrogenase was associated with mortality (HR 1.63 per 100 U/L; 95% CI 1.13-2.36; p = 0.010). Progression-free survival (PFS) was assessed in all patients; 134 PFS events occurred, and the median PFS was 3.9 years. Findings support LDH-informed risk stratification and timely ASCT referral in resource-limited settings and suggest a pragmatic, FISH-free prognostic approach incorporating hemoglobin where cytogenetics are unavailable.