Clinical and Laboratory Predictors of Mortality in Multiple Myeloma
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Background Multiple myeloma (MM) is a plasma cell malignancy characterized by bone marrow infiltration and organ dysfunction. Despite advances in treatment, the disease exhibits heterogeneous clinical outcomes, necessitating reliable prognostic markers. The prognostic significance of bone marrow plasma cell (PC) percentage and reticulin fibrosis in predicting mortality remains unclear and controversial in the literature. Methods We conducted a retrospective analysis of 97 patients diagnosed with multiple myeloma. Bone marrow PC percentage and reticulin fibrosis grade were assessed alongside comprehensive clinical, hematological, and biochemical parameters. Cox proportional hazards regression analysis was employed to identify independent predictors of mortality. Median follow-up and survival outcomes were calculated using Kaplan-Meier methodology. Results The median overall survival was 44.5 months. Higher bone marrow PC percentages correlated with increased reticulin fibrosis grade; however, neither parameter independently predicted mortality in multivariate analysis. Advanced age (> 68.5 years) and low platelet count (< 190.5×10³/µL) emerged as significant independent predictors of mortality. Additionally, elevated β2-microglobulin levels, renal dysfunction, elevated lactate dehydrogenase (LDH), and advanced International Staging System (ISS) stage were independently associated with increased mortality risk. Conclusion Age, platelet count, and established biochemical markers (β2-microglobulin, LDH, renal function) are reliable predictors of mortality in multiple myeloma, whereas bone marrow PC percentage and reticulin fibrosis grade do not independently predict survival outcomes. These findings support the prioritization of readily available clinical and laboratory parameters over bone marrow histological features for prognostication in MM. Further prospective multicenter studies are warranted to validate these findings and refine risk stratification strategies.
