P-141: Early Mortality in Newly Diagnosed Multiple Myeloma: Incidence and Risk Factors in an Indian Cohort

Introduction: Recent advancements in treatments have led to improved survival rates for Newly diagnosed multiple myeloma (NDMM) patients. Despite these advancements, early mortality (EM) remains a significant challenge. Research has identified several risk factors for early mortality in MM patients, including advanced age, male gender, poor performance status, and comorbidities such as renal and cardiac conditions. Infections and treatment-related toxicities also play a significant role in early mortality, emphasizing the importance of timely interventions and effective infection control measures. This study addresses the lack of data on Indian populations by identifying the rate, the causes and risk factors of early mortality among NDMM patients in India.

Methods: We conducted a retrospective analysis of 181 patients with NDMM at a tertiary medical center in India, from July 2022 to October 2023. Data were extracted from electronic medical records (EMR) covering patient demographics, clinical characteristics, treatment protocols, associated toxicities, and outcomes. Early mortality was defined as death within 180 days post-diagnosis.

The data analysis was performed using SPSS v21. We started with a univariate analysis using the chi-square test for categorical variables and an unpaired t-test for continuous variables to explore significant risk factors, followed by multivariate logistic regression.



Results: One hundred and eighty-one patients were analyzed of which 121 (66.9%) were males. The median age for the cohort was 55 years ( range: 30-85 ). The comorbidities were diabetes (27,14.9% of patients), hypertension (60, 33.1%), and ischemic heart disease (4, 2.2%). Based on disease characteristics, 53(29.3%) patients had an ECOG PS more than 2, 24 (13.3%) patients had hypercalcemia, 97 (53%) of the patients had anemia, 64 (35.4%) patients had hypoalbuminemia, LDH was raised in 81 (44.8%) patients.44 (24.3%) patients had renal damage, 154 (85.1%) patients had bony lesions, 60 (33.1%) patients had paramedullary lesions, and 12 (6.6%) patients had extraosseous disease.

Early mortality was observed in 17 patients (9.4%). Causes of death were disease-related ( 5 patients, 29.4% patients), infections (5, 29.4%), disease progression (3,17.6% patients ), other causes (2, 11.8%), and not available (1, 5.9%). Univariate analysis showed ECOG >2, hypercalcemia, hypoalbuminemia, presence of extraosseous disease, high R-ISS score, ISS score as the factors significantly associated with early mortality. Among these, extraosseous disease was found to be significant on multivariate analysis.



Conclusions: Early mortality continues to pose a significant challenge in the treatment of NDMM. Our population showed similar EM rates to the rates reported in literature for other populations, with a significant proportion of patients dying from disease related causes, progression, and infections. This suggests need for more effective therapies and infection prevention measures to optimise early outcomes.