Survie globale des patients âgés de moins de 65 ans, porteurs du myélome multiple sous chimiothérapie à l’Hôpital Général de Douala

Abstract

English Title: The overall survival of patients aged less than 65 years old with multiple myeloma under chemotherapy at the General Hospital of Douala

English Abstract

Abstract: the multiple myeloma or Khaler’s disease is a malignant hemopathy who falls under both old and young person. It is the second malignant hemopathy after the lymphomas. It is responsible for about 1% of death’s cancer and about 19% of death’s malignant hemopathy. The purpose of this study was to determine the overall survival of patients aged less than 65 years with multiple myeloma undergoing chemotherapy over a 10 years period at the General Hospital of Douala.

Method: it was a retrospective, descriptive and analytical study conducted in the department of internal medicine (Hematology unit) going on 05 December 2016 to June 30 2017. The sample method was non-random, with consecutive and exhaustive type of recruitment of patient records obedient of the inclusion criteria. The analyzed variables were demographic, paraclinical, therapeutic and evolutionary. The survival curves were plotted using the Kapplan Meier method. The survival comparisons were made by the Log Rank test and the p-values interpreted at a threshold of 5%.

Results: 51 patient’s records from 19 to 65 years old were eligible. The average age of patients was from 54,22 years to 8,608years. There was a slight female predominance with a sex ratio of 0, 21. The monoclonal gamma peak was in 81,81% of cases objective. The immunoglobulin G was predominant and the Kappa light evolution was found in 81, 1% of cases. Our patients were predominately on stage 3 of Durie and Salmon (70, 58%) and 50% at stage 3 of the ISS score. Our patients have been treated using VMCP, MP and MPT protocols. The VMCP was the most used protocol on the first and second line (58, 82% and 54, 16%) with a very good practical response rate of 60% in the first line. The second-line protocol choice and compliance were statistically significant on treatment response (p=0,02; p=0,026 respectively). For an average follow-up of 24,06 months (range: 1-120), the median SG was 38 months. The percentage of SG in 5 years was 26,90%. The median progression-free survival was 69 months. The survival with progression was 84, 36 months. The factors associated with the overall survival in our level were the protocol choice and the percentage of hemoglobin. (p= 0,04; p=0,08 respectively).

Conclusion: the patients are diagnosed at an advanced stage. The health care, the good compliance and the use of news molecules could improve the survival of our patients. This group of patients benefit from the therapeutic intensification by an auto implantation not yet available in our context.

Keywords: Mylemo of the young subject, survival, General Hospital in Douala