Complications and Associations in a Multiple Myeloma Cohort at Presentation

Abstract

Background: Myelomatosis accounts for about 10% of haematological malignancies according to previous studies in different climes. The impact of some complications on treatment choice as well as survival outcomes is significant and worthy of study. Aims: To describe complications observed at presentation in this cohort of myeloma patients and to assess the associations of these complications with certain laboratory and clinical parameters. Results: There were 37 males and 29 females, median age 61 years (Range 37-85). Median values at presentation was Hb - 8g/dL, serum albumin 37 mg/dL and calcium 2.5 mmol/L. Bence Jones proteinuria was present in 50% (17/34), majority (78.8% -26/33) had IgG myeloma and 7 (21.2%) IgA. They had nephropathy 19% (4/21), osteolytic lesions 34.7% (17/49), pathological fractures 56.1% (23/41), anaemia 91.4% (53/58) and hypercalcaemia 42% (21/50). commonest presenting symptom was bone pain in 87.2% (48/55). There was significant correlation between hypercalcaemia and haematocrit (r=0.338, p=0.039) and platelet count (r= 0.331, p= 0.029). No relationship was found between hypercalcaemia and beta -2 microglobulin (r= 0.046, p= 0.0834) or serum immunoglobulin (r= -0.071, p= 0.745). Pathological fractures showed no significant association with haematocrit (r= -0.137, p= 0.453), platelet (r= -0.097, p= 0.642), beta -2 microglobulin (r= -0.037, p= 0.865) and serum immunoglobulin (r= -0.132, p= 0.545). Chi square value for the occurrence of renal Impairment and hypercalcaemia was found to be significant r= 8.048, p= 0.007 as well as pathological fractures (r=8.048, p=0.005). Conclusions: Myeloma is prevalent in males 1.5:1. Bone pain and anaemia are the commonest features at presentation. Bence Jones proteinuria is only seen in about half of the patients and lytic lesions in about a third. Pathological fractures, anaemia or hypercalcaemia at presentation, were not associated with tumor stage (β-2 microglobulin and albumin levels). Significant association exists between the occurrence of renal impairment and pathological fractures.