Real-world outcomes of multiple myeloma in a resource-constrained setting: a 14-year experience from a tertiary cancer center in Jordan

• Outcomes of patients with MM in Jordan remain inferior to those in Western populations, due to limited access to advanced therapeutics. • Auto-HSCT remains a cornerstone of management of MM in developing countries. Multiple myeloma (MM) is a plasma cell malignancy with significant global disparities in outcomes owing to variable access to effective therapies. This study evaluates the clinical outcomes of patients with newly diagnosed MM (NDMM) undergoing autologous hematopoietic stem cell transplantation (auto-HSCT) at King Hussein Cancer Center (KHCC) in Jordan. We included all adult patients with NDMM who underwent auto-HSCT after first-line induction at KHCC between 2009 and 2023. Data on frontline regimens, before and after HSCT responses, and survival outcomes were collected. Responses were assessed using the International Myeloma Working Group criteria. Kaplan-Meier estimates were used for overall survival (OS) and progression-free survival (PFS), with log-rank tests for comparisons. A total of 221 patients were identified. The median age at diagnosis was 54 years (range, 32-67). The most common frontline regimen was bortezomib, thalidomide, and dexamethasone (42%), whereas only 2% received lenalidomide. The overall response rate to frontline therapy was 95%, with 2% achieving stringent complete response (sCR), 13% CR, and 50% very good partial response. After auto-HSCT, the sCR and CR rates increased to 13% and 35%, respectively. With a median follow-up of 48 months (range, 6-201), the median PFS was 41.1 months (95% confidence interval [CI], 37.9-47.2), and the median OS was 92 months (95% CI, 72-119). In conclusion, auto-HSCT significantly deepens responses in patients with NDMM, particularly in resource-limited settings. However, limited access to maintenance therapies and novel treatments underscores the need for broader therapeutic options to optimize MM care in such settings.