Multiple Myeloma in Iran: National Spatiotemporal Trends, Geographic Hotspots, and Projections to 2035

Multiple myeloma (MM) is a malignant plasma cell disorder with a rising global burden; however, comprehensive national analyses in Iran remain limited. This study evaluated the national and provincial burden of MM in Iran, identified spatial and temporal patterns, and forecasted trends through 2035.

Using data from the Global Burden of Disease Study 2021, we conducted an ecological analysis of MM incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in Iran from 1990 to 2021, by sex and province. Spatial patterns were assessed using Moran's I and Getis-Ord Gi* statistics in ArcGIS. Future trends were forecast using autoregressive integrated moving average models with exogenous variables (ARIMAX).

In 2021, Iran recorded 767 new MM cases (ASIR: 0.98 per 100,000), 2,006 prevalent cases (ASPR: 2.41 per 100,000), and 593 deaths (ASMR: 0.79), accounting for 15,873 DALYs (ASDR: 19.38 per 100,000). Men consistently showed higher rates than women. Spatial analyses identified central-western provinces, including Isfahan, Lorestan, Tehran, Alborz, and Qazvin, as incidence and prevalence hotspots, while Zanjan and Markazi were identified as coldspots. Mortality and DALY hotspots were concentrated in Isfahan, Hamedan, Alborz, and Qom, whereas Mazandaran and Ilam showed lower burdens. Forecasts indicate continued increases by 2035, with incidence projected to reach 1.30 per 100,000 and prevalence projected to reach 3.15 per 100,000. Temporary declines during 2020-2021 likely reflected COVID-19-related disruptions in diagnosis and reporting.

The burden of MM in Iran is increasing and geographically unequal. Strengthening early detection, diagnostic capacity, treatment access, and region-specific cancer control strategies is essential to reduce disparities and improve outcomes.