Associated factors for identifying one-year mortality among Thai patients with multiple myeloma: a single-center retrospective study

Abstract

Introduction An early mortality in multiple myeloma (MM) remains a major concern, especially in resource-limited settings. Data on early mortality in Thailand are limited.

Objectives This study aimed to identify factors associated with early mortality and to describe overall survival (OS) and causes of death among patients with newly diagnosed MM (NDMM).

Patients and methods This retrospective study included 153 patients with NDMM diagnosed between January 1, 2018, and May 31, 2023, at Maharat Nakhon Ratchasima Hospital. Early mortality was defined as death within 12 months after diagnosis. Clinical and laboratory data were analyzed using univariable and multivariable Cox regression. Causes of death were classified according to a systematic classification of death causes in multiple myeloma.

Results Early mortality occurred in 63 patients (41.18%). In multivariable analysis, older age (hazard ratio [HR] 1.07, 95% CI 1.01–1.16, p = 0.034) and ꞵ2-microglobulin (ꞵ₂M) ≥ 5.5 mg/L (HR 1.32, 95% CI 1.03–1.67, p = 0.026) were independent predictors of early mortality. Patients receiving conventional chemotherapy and those achieving less than partial response were also at increased risk. Most deaths (92.1%) were MM-dependent, of which 58.6% were progression-related and 41.4% were therapy-related. Infections accounted for 50.8% of all deaths. Median OS was 19.97 months.

Conclusion Older age and ꞵ₂M ≥ 5.5 mg/L were independent predictors of early death, while conventional chemotherapy and poor treatment response further increased risk. Reducing early mortality requires improved early detection, optimized treatment, expanded access to novel agents and targeted infection-prevention strategies for high-risk patients.