A Review of Epidemiology and Management of Multiple Myeloma in a Resource Poor Country

Abstract

Multiple myeloma (MM) is a B-cell malignancy characterized by clonal proliferation of terminally differentiated B lymphocytes. Rational use of proteasome inhibitors, immunomodulators, anti CD38 or CD 138, and tandem autologous stem cell transplant have improved 5-year overall survival beyond 50% in advanced countries. However, the disease prevalence is probably highest in Sub-Saharan Africa where diagnostic and treatment facilities are lacking. The authors have reviewed published articles on epidemiology and outcomes of MM in Nigeria in the light of international recommenda-tions with the aim of suggesting adaptable practices in a resource-poor environment. Publications from Nigeria were obtained from search engines such as Google Scholar and PubMed while recent guidelines were obtained from websites of the National Compre-hensive Cancer Network and Medscape Oncology. The mean age at presentation ranged between 54 and 62 years, and there was a higher prevalence among males (ratio 1.1: 1–4.4: 1). A study in Nigeria found an increased incidence in oil-producing areas. In earlier publications between 2005 and 2007 years, about a quarter of patients could not afford treatment and most of the patients presented in advanced stages of the disease. During that period, the mean survival was 7 months and only 13.3% lived beyond 2 years. The treatment then was based on either melphalan ± prednisolone or combination of vincristine, adriamycin, and dexamethasone. By 2012/14, thalidomide, bortezomib, biphosphonates, radiotherapy, and renal dialysis were introduced with a mean survival of 4 years. Optimization of available facilities would, therefore, improve the disease-free survival.