Characteristics and Results of the Treatment of Multiple Myeloma in the Subject under the Age of 65 at the University Hospital of Yopougon in Abidjan, Côte d’Ivoire

Abstract

We retrospectively studied 30 cases of multiple myeloma in patients under the age of 65, diagnosed from 1991 to 2005 in the clinical hematology department of the University Hospital of Yopougon that is a hospital incidence of 2.9 cases/year. The age of patients ranged from 34 to 64 years, with a mean age of 49 years and a sex ratio of 1.73. The professional activity was variable with 3% of radiographers and 10% of farmers. Clinically, the dominant sign was bone pain in 83% of cases. Myeloma was secretory in 93% of cases. It was Ig G-type in 86%, kappa-type in 66% of cases. 86% of patients were anemic, 20% had creatinine >20 mg/L, and 10% had serum calcium >120 mg/L. Geodes were found in 80% of cases. 53% were at stage III of DURIE and SALMON. Complications were infectious (33%), renal (20%), and hemorrhagic (7%). Chemotherapy regimens were VAD (10%), VMCP (30%), and VMCP/VBAP (60%) with 47% of partial responses, 33% of stable disease, and 7% of very good quality partial responses. The outcome developed towards death in 37% and causes of death were renal in 46% of cases. The median survival was only 5.1 months.

The VACD-Thal Protocol in the Treatment of Multiple Myeloma in Abidjan (Côte D’ivoire)

“…Our results were similar to the Cameroonian and Tunisian series [10,15]. IgM kappa MM was predominant in our series, identical in European and African studies [4,8,9,15,16]. In terms of prognosis, the majority of our patients were classified at stage III of the ISS (78.8%).…”

“…This could be explained by the experience of life which is lower in Africa unlike developed countries. For the sexes, we constated a predominance of male sex similar at the data of the literature [4,9]. The predominance of women has been found in Cameroon [10].…”

“…It was 63.6% of VGPR, 21.2% PR. Our results are superior to those of Cameroon and Tunisia, which found respectively a good response in 60% and 65.2% of cases with chemotherapy alone and superior to the previous study of Tolo et al in Côte d'Ivoire, which found 7% of PR with chemotherapy alone [4,15,21]. The secondary effects of our protocol were dominated by peripheral neuropathies (63.6%), neutropenia (54.5%) and anemias (18.2%).…”

“…Thus conventional chemotherapy remains the only therapeutic alternative for the management of our patients. Some previous studies with chemotherapy alone with the alternate VACD / VBMP protocol, 12 to 16 cycles reported an RP of 47% [4]. Our study proposes to evaluate the association of the chemotherapyimmunomodulator in the management of MM in Africa.…”

“…In Europe, its incidence is 4.5-6.00 / 100,000 inhabitants / year; while in the United States it is 4.3 per 100,000 inhabitants [2,3]. In Côte d'Ivoire, the hospital incidence was estimated at 2.9 cases / year between [4]. The therapeutic history of this disease is marked by the advent of new molecules such as immunomodulators since 1957, proteasome inhibitors, monoclonal antibodies and histone deacetylase inhibitors.…”