Bone Marrow Findings And Prognostic Indicators In Multiple Myeloma Patients

Abstract

Background: Multiple myeloma (MM) is a plasma cell malignancy with heterogeneous clinical and pathological features. Early characterization of bone marrow findings, immunophenotypic profiles, and cytogenetic abnormalities is essential for risk stratification and guiding treatment strategies, especially in resource-limited settings like Bangladesh. Methods: This cross-sectional observational study was conducted in the Department of Haematology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2022 to June 2023. A total of 60 newly diagnosed, untreated MM patients were included based on clinical features, biochemical parameters, serum protein electrophoresis, and bone marrow examination. Results: The mean age of patients was 59.8 ± 9.6 years, with 61.7% being male and 58.3% from rural areas. Common presenting symptoms included bone pain (76.7%), anemia (70.0%), and fatigue (65.0%). Laboratory results showed anemia (mean Hb: 8.9 ± 1.6 g/dL), elevated ESR, calcium, creatinine, β2-microglobulin, LDH, and CRP. Bone marrow plasma cell infiltration ranged from 31–60% in 46.7% and >60% in 30.0% of patients. The most frequent infiltration pattern was diffuse (40.0%), and 45.0% had mature plasma cell morphology. Immunophenotyping showed universal CD138 positivity, with high expression of CD38 (98%) and aberrant CD56 (84%). CD19 negativity was seen in 90% of cases. Cytogenetic abnormalities included gain of 1q21 (20.0%), del(17p13) (18.0%), and t(4;14) (14.0%). Based on R-ISS, 48.3% were Stage II, 31.7% Stage III, and 20.0% Stage I. Conclusion: A significant proportion of MM patients presented with advanced disease, highlighting the need for early diagnosis and comprehensive diagnostic workup for better risk stratification and management.