Abstract

Background: Multiple Myeloma (MM) is a hematological malignancy characterized by clonal proliferation of plasma cells, which produce monoclonal immunoglobulins referred to as M-protein. In this study we aim to study the demographic characteristics and evaluate the clinical, biochemical, hematological and radiological profile of MM in a tertiary care centre in Bihar.
Materials and Methods: Newly diagnosed and previously diagnosed but untreated patients of MM coming to Hematology department over a period of two and a half years (June 2019 to Nov 2021) were included in this retrospective observational study. Diagnosis was confirmed by the Revised International Myeloma Working Group diagnostic criteria. The cases were re-evaluated taking into consideration clinical aspects, biochemical findings, radiological results, hematological profile and bone marrow findings.
Results: During this study a total of 64 cases fulfilled the diagnostic criteria. Mean age of the patients was 55.6 years with a male-to-female ratio of 2.8:1. Most common symptom was generalized weakness (87.5%) followed by backache and other bone pains (80%). 92% patients had anaemia. There were 4 (6.3%) cases of plasma cell leukemia. Albumin-to-globulin ratio was reversed in 83% cases. Hypercalcemia was seen in only 17.2% patients and elevated serum creatinine levels in 47% cases.  80% cases had radiologically detectable abnormalities. On immunotyping most common type was IgG.  9.4% cases had plasmablastic morphology on bone marrow examination. Majority of the cases had interstitial pattern of infiltration. As per Durie-Salmon staging system, majority cases were in stage III (66%).
Conclusion: Most of the patients were in sixth decade of life, but cases as young as 19 years was seen. Generalised weakness and bone pain were the most common presenting symptoms. Majority of patients were in higher stages at the time of diagnosis. The diagnosis of MM requires a systematic approach. Bone marrow aspiration combined with bone marrow biopsy provides necessary information on the level of bone marrow involvement by plasma cells and its morphological characteristics. They should be employed as a routine procedure in all cases.