Multiple myeloma (MM) is a malignant disorder of plasma cells characterized by clonal proliferation within the bone marrow^1,2. Excessive production of monoclonal immunoglobulins or light chains leads to anemia, renal dysfunction, immunosuppression, and skeletal complications ^1,2.

Globally, multiple myeloma accounts for approximately 1% of all cancers and about 10% of hematologic malignancies, with an estimated 160,000 new cases annually and a higher prevalence among men ³. In India, MM represents approximately 1–2% of all cancers, with a rising incidence attributed to improved diagnostic facilities and an aging population ⁴. The disease frequently presents at an advanced stage, underscoring the importance of early detection and assessment of bone marrow involvement⁵.

The hallmark of multiple myeloma is the clonal proliferation of malignant plasma cells within the bone marrow, which may be classified morphologically as plasmacytic or plasmablastic⁶. Plasmacytic cells are mature-appearing with eccentric nuclei, perinuclear hof, and basophilic cytoplasm that may contain Russell bodies, whereas plasmablastic cells are immature, exhibit a high nuclear-to-cytoplasmic ratio, prominent nucleoli, and dispersed chromatin, and are associated with aggressive disease and poor prognosis ^6,7. Expansion of malignant plasma cells suppresses normal hematopoiesis, resulting in anemia, neutropenia, and thrombocytopenia ^1,8. Additionally, myeloma cells alter the bone marrow microenvironment through secretion of cytokines such as interleukin-6 (IL-6) and receptor activator of nuclear factor-κB ligand (RANKL), leading to increased osteoclast activity and inhibition of osteoblast function. This imbalance results in bone destruction, lytic lesions, and hypercalcemia, while dysregulation of stromal and immune cells further supports plasma cell survival and contributes to immunodeficiency ^9,10. These bone marrow abnormalities form the basis of the clinical manifestations, disease progression, and prognosis in multiple myeloma.

Study Design

This was a descriptive observational study.

Study Setting

The study was conducted in the Department of Pathology of a tertiary care teaching hospital in India.

Sample Size

A total of 30 patients with a confirmed diagnosis of multiple myeloma were included in the study.

Inclusion Criteria

• Patients diagnosed with multiple myeloma based on clinical evaluation and bone marrow examination, in accordance with standard diagnostic criteria
• Newly diagnosed, treatment-naïve patients
• Patients with adequate bone marrow aspiration and/or trephine biopsy material
• Patients who provided  informed consent

 Exclusion Criteria

• Patients who had received prior chemotherapy, radiotherapy, or immunotherapy for multiple myeloma
• Patients with plasma cell dyscrasias other than multiple myeloma
• Patients with inadequate, poorly preserved, or hemodiluted bone marrow samples
• Patients with concurrent hematological malignancies
• Patients unwilling or unable to provide informed consent

Methodology

After obtaining informed consent, relevant clinical details including age and gender were recorded. Bone marrow aspiration and trephine biopsy were performed under strict aseptic precautions. Smears were stained using standard hematological stains and examined microscopically to assess the percentage of plasma cells. Plasma cells were classified into plasmacytic and plasmablastic types based on cytomorphological features. Disease staging was performed according to the percentage of plasma cells in the bone marrow.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using descriptive statistical methods. Results were expressed as frequencies, percentages, and mean ± standard deviation.

Ethical Approval

 Ethical clearance was obtained from the Institutional Ethics Committee prior to initiation of the study.

Table 1   Gender

Out of the 30 patients included in the study, 17 (56.7%) were male and 13 (43.3%) were female, indicating a slight male predominance.

Table 2   Mean Age

 The mean age of the patients was 54 ± 1.6 years, indicating that multiple myeloma in this cohort predominantly affected middle-aged adults.

Table 3   Plasma Cell Type

Among the 30 patients, 12 (40%) exhibited plasmacytic morphology, while 18 (60%) showed plasmablastic morphology, indicating that the majority of cases had an aggressive plasma cell type.

Table 4   Staging

Based on bone marrow plasma cell percentage, 3 patients (10%) were classified as Stage I (<20% plasma cells), 10 patients (33.3%) as Stage II (20–50% plasma cells), and 17 patients (56.7%) as Stage III (>50% plasma cells), indicating that most patients presented with advanced-stage disease.

Multiple myeloma (MM) is a hematological malignancy characterized by clonal proliferation of plasma cells in the bone marrow, resulting in bone marrow failure, skeletal complications, renal impairment, and immunodeficiency. In the present study of 30 patients, the male-to-female ratio was 17:13 (1.3:1), consistent with global trends showing a slight male predominance in MM. Similar findings have been reported in Indian studies, where men are more commonly affected than women, likely due to a combination of genetic, hormonal, and environmental factors^11,12

The mean age of patients was 54 ± 1.6 years, which aligns with previous studies reporting the median age of onset between 50 and 60 years. This is slightly younger than Western populations, where the median age at diagnosis is typically around 65–70 years, possibly reflecting differences in population demographics and life expectancy^13,14

In terms of plasma cell morphology, 60% of cases were plasmablastic, while 40% were plasmacytic. Plasmablastic morphology is generally associated with more aggressive disease, higher proliferation rates, and poorer prognosis, consistent with the higher proportion of patients presenting in Stage III disease (56.7%) in this cohort,which aligns with previous studies. The predominance of advanced-stage disease is in line with other Indian studies, where late presentation is common due to limited early detection and healthcare access^15,16.

Staging based on bone marrow plasma cell percentage showed that most patients had >50% plasma cells, reflecting advanced marrow involvement. This correlates with the high prevalence of plasmablastic cells and suggests that marrow infiltration may be a key driver of disease severity in this population. The findings highlight the importance of early diagnosis and bone marrow assessment to guide prognosis and management^17,18.

Overall, this study confirms that MM in India presents at a slightly younger age, often with advanced disease, and with a significant proportion of aggressive plasmablastic morphology. These observations emphasize the need for awareness, early detection, and timely intervention to improve outcomes in Indian patients with multiple myeloma^19,20.

Multiple myeloma in this study predominantly affected males and presented at a relatively younger age compared to Western populations. Plasmablastic morphology was more common than plasmacytic, correlating with advanced-stage disease and high bone marrow plasma cell infiltration. These findings highlight that MM in India often presents with aggressive disease, emphasizing the importance of early diagnosis, bone marrow evaluation, and timely intervention to improve prognosis and clinical outcomes.

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