Clinico-haematological profile of patients of multiple myeloma and response to bortezomib based induction

Introduction: Multiple myeloma is characterized by proliferation of a clone of plasma cells that manifest by one or more lytic lesions, monoclonal (M) protein in the blood or urine and bone marrow involvement, ( Sirohi and Powles, 2004) having varying presentation and hematological features. Complications such as renal failure, infections, anemia, lytic bone lesions and amyloidosis lead to morbidity as well as mortality (UK myeloma forum, 2001). Though untreated the disease is uniformly fatal, newer advances in treatment like autologous hematopoietic stem cell transplantation, mini–transplants and advances in chemotherapy have improved the quality of life and increased survival (Gupta et al., 2002). The three drug regimens that contain bortezomib (proteasome inhibitor), thalidomide (immunomodulator) and dexamethasone (VTD) is highly effective in newly diagnosed myeloma (Richardson et al., 2010). Aim and Objectives: To study the clinicohematological profile of patients of multiple myeloma and response to bortezomib based induction. Material and Methods: This was a cross sectional study conducted at Pt. B.D. Sharma PGIMS, Rohtak on all newly diagnosed multiple myeloma patients attending the haematology department, wards and OPD from Feb 2016 to Nov 2017. All newly diagnosed cases who fulfilled the diagnostic criteria of multiple myeloma by IMWG were included in study. Patient’s detailed history, physical examination and hematological parameters and other investigations and response to bortezomib based induction recorded on a study proforma and data was analyzed using standard statistical methods. Results: The study population consisted of 16 male patients and 14 female patients with male to female ratio 1.14:1. Mean age was 56.43±10.58 years. The common clinical symptom were bone pain seen in 83.33% of patients followed by weakness/fatigue (53.33%), renal failure (20%), polyuria/polydipsia (13.33%), infections/fever (10%), isolated bony swelling (6.67%) and neurological features seen in 3.33% of cases. On examination, 90% patients had pallor. Anemia was normocytic and normochromic in maximum of patients (46.67%) and ESR was raised in all patients and 90% patients had ESR >100 mm in 1st hour. 33.33% patients had hypercalcemia with serum calcium ≥11 mg/dl and 33.33% patients had renal insufficiency with serum creatinine ≥2 mg/dl. M-band was positive in all patients. Bone marrow plasmacytosis >50% was seen in 46.67%. Bence Jones proteinuria was seen in 30 % of patients and on skeletal survey lytic lesions were seen in 66.67 % of patients. ORR to VTD induction was 86.67%. Conclusion: Overall response rate (ORR) was 86.67%, 56.67 % patients achieved ≥VGPR hence VTD is highly active induction therapy before ASCT.