Diagnosis, treatment, and outcomes of multiple myeloma in Armenia: A real-world experience from a developing country.

Abstract

e19513 Background: In Armenia, multiple myeloma (MM) is one of the most frequent hematologic malignancies. The aim of this study is to evaluate diagnostic and treatment modalities as well as outcomes of MM in Armenia during the last 7 years. Methods: For this retrospective hospital-based study we have collected data from the main hematology center in Armenia: Yeolyan Hematology and Oncology Center. The information about patients with MM treated during 01/01/2017 - 31/12/2022 period was collected from the medical records. Log- rank test and Kaplan-Meier curves were used for survival analysis. Results: 247 patients with MM were involved in final analysis. Male to female ratio was 1:1.1. Median age at diagnosis was 62 years. Median follow up time was 26 months. 0.4% of patients were diagnosed with Durie-Salmon stage I, 12.6% stage II, 72.5% stage III MM and for 14.6% Durie-Salmon stage was unknown. The ISS staging was done for only 32.8% of patients. Only 28.7% of patients were diagnosed with MM matching IMWG 2014 criteria. 54.3% of patients received only 1 line of chemotherapy, 25.9% 2 lines, 8.9% 3 lines, 1.2% 4 lines, 0.4% 5 lines of chemotherapy and 9.3% did not receive any treatment at all. 74.1% of treated patients received 1 st line chemotherapy with proteasome inhibitor (PI) containing regimens, 4% immunomodulator agent (IMID) containing regimens, 8% both of these agents and 13.8% didn’t receive any of these agents during 1 st line chemotherapy. 61.6% of treated patients received less than 6 cycles of chemotherapy during 1 st line treatment. At the time of data analysis only 36.0% of patients were alive. Median OS was 32 months for the whole cohort. Patients who were diagnosed with Durie Salmon stage I-II MM had significantly better median OS than those with stage III (56 vs 25 months; p=0.003). One of the main prognostic factors affecting OS was ASCT. Patients who had undergone ASCT during their curse of treatment had significantly better median OS (60 vs 31 months; p<0.001). Maintenance chemotherapy was also one of the most significant prognostic factors for OS (56 months with maintenance vs 22 months without (p<0.001)). Median OS for those patients who received 1 st line chemotherapy with PIs, IMIDs or both was 41 months, 26 months for those treated without PIs and IMIDs and 4 months for those who didn’t receive chemotherapy at all (p<0.001). Median OS was significantly better for those who received more than 5 cycles of chemotherapy during 1 st line treatment (44 vs 27 months, p=0.013). The main independent prognostic factors for OS by univariate and multivariate Cox Regression analysis were ASCT, number of 1 st line chemotherapy cycles and maintenance treatment after 1 st line chemotherapy (p<0.05). Conclusions: Our survival rates are much lower compared to that of developed countries. The ASCT, maintenance chemotherapy and number of 1 st line chemotherapy cycles were the most influential factors for patients’ survival.