Clinical characteristics and prognosis of newly diagnosed multiple myeloma patients with hypercalcemia: a retrospective cohort study.

OBJECTIVE: To investigate the clinical characteristics and identify prognostic factors in patients with newly diagnosed multiple myeloma (NDMM) who presenting with hypercalcemia. METHODS: We retrospectively analyzed clinical and laboratory data from 82 NDMM patients with hypercalcemia who were admitted to the Department of Hematology at Zhongda Hospital (Southeast University) and Jiangning Hospital (Nanjing Medical University) between January 2015 and December 2024. 80 patients without hypercalcemia were randomly selected as a control group for comparison. Prognostic evaluations were based on overall survival (OS), progression-free survival (PFS), and minimal residual disease (MRD) status. Survival rates were estimated using the Kaplan-Meier method, with univariate analyses performed via the Log-rank test and multivariate analyses utilizing the Cox proportional hazards regression model. RESULTS: The cohort comprised 82 patients (51 males, 31 females). By the end of the follow-up period, with the median follow-up time was 51 months (range, 6-128): 59 patients had died and 23 were alive. Univariate analysis revealed that cytogenetic abnormalities (detected by FISH), serum creatinine, ferritin, MRD status, and serum calcium levels significantly affected both OS and PFS. Multivariate Cox regression demonstrated that the presence of ≤ 1 FISH abnormality and MRD negativity were independent protective factors for OS. Notably, elevated serum ferritin (≥500 ng/mL), a marker previously underexplored in this context, emerged as a robust independent risk factor for both OS and PFS. Severe hypercalcemia (≥3.5 mmol/L) was also identified as an independent risk factor for both OS and PFS. For PFS, MRD negativity remained an independent protective factor, whereas ferritin ≥500 ng/mL and serum calcium ≥3.5 mmol/L were identified as independent risk factors. CONCLUSION: NDMM patients with hypercalcemia exhibited a substantial tumor burden, heterogeneous clinical manifestations, and a high rate of early mortality. Prompt correction of serum calcium levels, with adjustment for concurrent hypoalbuminemia, is imperative. Early detection and optimal management of hypercalcemia are essential to refining treatment strategies and improving survival outcomes.