Abstract
BACKGROUND: Multiple myeloma (MM) substantially impairs health-related quality of life (QoL). Evidence from low- and middle-income countries is limited, and identifying reliable predictors of QoL is essential to guide supportive care strategies. METHODS: We conducted a multicenter cross-sectional study of 202 MM patients from six hospitals in the West Bank, Palestine (2018-2025). Patients completed the validated Arabic EORTC QLQ-MY20 questionnaire. Clinical, demographic, and therapeutic variables were collected, and predictors of QoL subscales were analyzed using non-parametric tests and multivariable linear regression with LASSO variable selection. RESULTS: In the Side Effects of Treatment subscale, abdominal pain (β = 6.75; 95% CI: 1.92-11.59; p = 0.006), chest pain (β = 9.63; 95% CI: 4.25-15.01; p < 0.001), and swelling (β = 8.15; 95% CI: 2.90-13.40; p = 0.002) were strong independent predictors, while autoimmune disease and peptic ulcer showed borderline associations. For the Body Image subscale, gout (β = - 22.06; 95% CI: - 38.95 to - 5.18; p = 0.010) and peptic ulcer (β = - 25.82; 95% CI: - 47.18 to - 4.46; p = 0.018) significantly worsened patient perceptions, with serum calcium showing a borderline effect (p = 0.052). In the Future Perspective subscale, chest pain demonstrated a borderline negative association (β = - 8.15; 95% CI: - 16.72 to 0.42; p = 0.062), while other predictors showed no significant effects. LASSO models confirmed stable predictor sets with low multicollinearity, explaining 25.9% (SE), 10.5% (Body Image), and 2.4% (Future Perspective) of variance, respectively. CONCLUSIONS: Specific symptoms (abdominal pain, chest pain, swelling) and comorbidities (gout, peptic ulcer disease) emerged as important determinants of QoL in MM patients. Cardiopulmonary complaints also suggested a psychological burden on future outlook. These findings highlight the need for integrated symptom management and comorbidity-focused supportive care, particularly in resource-limited healthcare systems such as Palestine.