Experience with multiple myeloma in a public referral hospital in Nairobi, Kenya

Abstract

Multiple myeloma is a clonal malignant proliferation of the plasma cell line in terminal stages of immunological maturation of the B cell lineage. It has a male-to-female ratio of 2/1 and affects mainly the middle aged and elderly. It has not been characterized comprehensively locally. Methods: We retrospectively studied records of patients seen at the Kenyatta National Hospital, Nairobi between January 1994 and January 2004 inclusive. Information sought included demographic, clinical, radiologic, haematologic, biochemical, treatment and outcome details. Results: Records were available for 173 patients, 100 males and 73 females (M/F = 1.37/1). Median age was 53 years, range 31-83 years. Fourteen of 165 evaluable for age (8.5%) were less than 40 years, 19 (11.5%) were aged ≥70. Main presenting complaints were lower back pain in 52 (27.4%) and weakness or total paralysis of lower limbs in 50 (26.3%) of 190 presenting complaints. Generalised weakness, generalized bone aches and pathological fractures were also common. Haemoglobin level at diagnosis was < 8.5g/dl in 34.8%, 8.5-9.9g/dl in 15.2%, and > 10g/dl in 50% of 92 cases. Bone marrow plasmacytosis was < 10% in 8% and >30% in 71.6%of 74 cases. Urinary Bence-Jones proteins were demonstrable in 32.7% of 52 cases evaluable, and serum paraproteins in 75% of 56 cases. Blood urea nitrogen was ≥ 10.7 mmols/l in 39.7% of 58 cases evaluable and blood calcium ≥ 2.64 mmols/l in 19.1% of 42 cases evaluable. Melphalan and prednisone were used upfront in 94.4% of 107 cases evaluable and palliative radiotherapy was given to 91.3% of 115 cases evaluable. 4.4% had orthopedic maneuvers. The median followup duration was 15 months, range < 1-120 months. 24 patients were recorded dead after a median survival of 7.5 months. Conclusions: Multiple Myeloma in our setup occurs most commonly in 6th/ 7th decades. Lower back pain with lower vertebral collapse causing weakness of lower limbs are the main presentations. Melphalan and prednisone plus palliative radiotherapy are the mainstays of management. Follow-up durations and survival are short.

Presentation and survival of multiple myeloma patients in Ghana: a review of 9 cases

“…Nearly one-third of patients were 50 years of age or younger, an observation that has also been noted by Odunukwe et al in Nigeria 16. Seven percent of patients were 40 years or younger, which is consistent with other reports from elsewhere in Africa,14,16,19 but twice as many as reported for Caucasians. Since this observation could be biased by the lower life expectancy in Africans, adjusting the incidence for age would allow for more reliable comparison.…”

“…With a high prevalence of bone pain in the study population, it is likely that many of the patients in Ghana would have been prescribed NSAIDs by the time of referral, which could contribute to the development of renal impairment. One third of patients had hypercalcaemia, similar to a report from Kenya,11 however there is a wide variation (6.8–69%)in the prevalence of hypercalcaemia in Africans at diagnosis 12,13,19. Lytic lesions were more often detected on skull imaging, a reflection of the local protocol for investigating suspected myeloma.…”

“…Bortezomib and lenalidomide were the two other novel agents available in Ghana, but few patients were able to afford them. The overall median survival of 33 months (range, 0 – 138 months) in this study compares favourably with centres where MP was the predominant treatment 16,19,24. The utility of the ISS staging criteria method in a wholly African patient population is supported by the inverse association of stage with survival in the stage-specific survival curves.…”

“…Men are slightly more likely to be diagnosed with MM than women, regardless of race 10,19,20. However studies from Cameroon15 and Sudan21 have reported wide variations in male-female distribution.…”

Retrospective Analysis of Presentation, Treatment, and Outcomes of Multiple Myeloma at a Large Public Referral Hospital in Eldoret, Kenya

“…The median age at diagnosis reported in this and other sub-Saharan Africa studies ranging from 53 to 62 years was closer to that reported for the African American population (65 years) and lower than that reported for White patients (71 years). 10 , 11 , 15 - 17 It appears that sub-Saharan Africans are at risk of early onset MM, a characteristic that has been confirmed in the African American population. 17 …”