Objective  To study the clinical features and risk factors of death within the first chemotherapy cycle in multiple myeloma (MM).

  Methods  From 2004 to 2012, 111 patients with MM received first-line chemotherapy. Their clinical data were recorded and analyzed retrospectively.

  Results  A total of 15 patients died within six months after diagnosis, whereas 10 patients (9%) died within the first chemotherapy cycle. The median overall survival was five days. The monoclonal protein isotype of 10 patients was as follows: light chain only, 7; IgG, 3.8 of 10 cases of deaths were attributed to infection and complications. Univariate analysis revealed that light-chain myeloma, thrombocytopenia, leukopenia, neutropenia before treatment, high ECOG score, and high serum creatinine were predictors of death within the first chemotherapy cycle. Logistic regression modeling identified light-chain myeloma (P=0.003, OR 12.976, 95% CI: 2.328 to 72.322), thrombocytopenia (P=0.034, OR 6.141, 95% CI: 1.152 to 32.739), and neutropenia (P=0.003, OR 13.639, 95% CI: 2.398 to 77.564) as independent predictors.

  Conclusion  Fatal risk could be elevated by the first cycle of chemotherapy in some patients with MM. The causes of death within the first chemotherapy cycle were mainly serious infection and complications. The prognostic factors of MM could not effectively predict the mortality risk of induction chemotherapy. Light-chain myeloma, thrombocytopenia, and neutropenia were independent predictors of death within the first chemotherapy cycle.