Clinical profile, treatment patterns, and survival outcomes of multiple myeloma patients in the Middle East: Real-world data from Bahrain.

Abstract

e19576 Background: Real-world data from the Middle East in myeloma is limited, despite unique demographic factors that may affect outcomes. In this study we aimed to describe clinical profile, treatment patterns, and predictors of survival in myeloma patients treated in routine practice in Bahrain. Methods: We conducted a retrospective, cohort study of adult patients diagnosed with myeloma in the national oncology center in Bahrain from 2017 to 2023. Baseline clinical, and laboratory parameters, and treatment patterns (induction regimens, use of autologous stem cell transplantation (ASCT), and maintenance strategies), were recorded. Progression-free survival (PFS), overall survival (OS), and factors associated with survival were estimated. Results: One hundred and fifty-five patients were included in the study, the median age at presentation was 62 years (range 25–86 years). Most patients had advanced disease at presentation: 52% were ISS Stage III, and only 23% were Stage I. High-risk cytogenetics were identified in 15% of those tested, and circulating plasma cells were seen in 7% at diagnosis. The predominant immunoglobulin subtype was IgG (67%), followed by light-chain–only disease (19%), and IgA (13%). Kappa light chain restriction was more common (68%) than lambda (32%). Induction regimens demonstrated evolution over time in accordance with global paradigms- VCD, VTD and VRD regimens predominated pre-2020, and DVRD and DVD regimens predominated post-2020. Responses to first-line therapy were favorable: 76% complete response (CR), 12% very good partial response (VGPR), and 12% partial response (PR). 68% patients were ASCT-eligible, and 51% underwent ASCT. Depth of response improved further following transplantation: 90% CR, 8.5% PR, and 1.4% stable disease. Post-transplant maintenance therapies included IMiD (65%), proteasome inhibitor (15%), dual maintenance (11%), or single anti-CD38–based maintenance (9.1%). At a median follow-up of 3.4 years, the median PFS in R-ISS stages I, II and III patients were 12.8, 6, and 2.6 years respectively. On multi-variable analysis (MVA), baseline renal impairment had worse OS (HR 3.29, 95% CI, 1.16 – 9.34), while ASCT was strongly associated with improved OS (HR 0.11 95% CI, 0.03 – 0.44). Patients with circulating plasma cells at baseline, and IgA subtype showed trend toward inferior survival (p=0.05). R-ISS stage III was associated with inferior PFS (HR 6.27, 95% CI 1.50 – 26.28) on MVA. Conclusions: In this real-world cohort of Middle Eastern ethnicity, myeloma frequently presented at advanced stages, however modern treatment approaches, including ASCT, resulted in comparable survival outcomes to that described in literature. Our study provides region-specific evidence that complements clinical trial data, and supports the effectiveness of modern myeloma treatments in Middle Eastern populations.