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

Abstract

PURPOSE Treatment patterns and survival outcomes of patients with multiple myeloma (MM) in Kenya have not been adequately characterized. The objectives of this study were to describe the clinical, laboratory, and imaging findings at diagnosis, to describe the treatment offered, and to determine the survival outcomes of patients with MM over an 11-year period. PATIENTS AND METHODS A retrospective chart review was carried out for all patients who were diagnosed and treated for MM at Moi Teaching and Referral Hospital from 2009 to 2019. The Kaplan-Meier method was used to estimate survival. Factors affecting survival were identified using univariate and multivariate analyses. RESULTS A total of 221 patient charts were analyzed of which 124 belonged to male patients (56.1%). The median age at diagnosis was 61 years. Bone pain was the most common presenting complaint observed in 69.6% of 194 patients assessed. Out of 102 patients who received imaging studies, 60 (58.8%) had lytic lesions, 30 (29.4%) had fractures, whereas 30 (29.4%) had spinal cord compression. Anemia, renal failure, and hypercalcemia were observed in 87/187 (46.5%), 22/161 (13.7%), and 23/42 (54.8%) patients, respectively. Thalidomide and dexamethasone (65.2%); bortezomib, thalidomide, and dexamethasone (14.6%); and melphalan and prednisolone (11.9%) were the most prescribed initial chemotherapy regimens among 219 patients analyzed. Overall survival at 1 and 5 years was 70% and 21%, respectively; median overall survival was 29.0 months. In multivariate analysis, male sex (hazard ratio [HR] 1.9), baseline anemia (HR 1.8), and baseline renal failure (HR 3.2) were associated with significantly shorter survival. CONCLUSION Survival outcomes were poor despite increased use of multiagent-based chemotherapy regimens. Greater access to available diagnostics and treatments is required to achieve rational treatment and increased survival.

Immunophenotypic expression profile of multiple myeloma cases at a tertiary hospital in Nairobi Kenya

“…Our findings from the demographic variables in this study were similar to those from previous MM studies carried out in Sub-Saharan Africa that have reported a male predominance and median age at presentation of between 53 to 62 years (5,6,(40)(41)(42). This is a younger age at diagnosis than described in studies conducted in predominantly Caucasian populations such as that by Kyle et al and Kristinsson et al who reported a median age of 66 and 70 years, respectively, (43,44).…”

“…This heterogeneity has been observed among different racial groups. The incidence of MM and Monoclonal Gammopathy of Undetermined Significance (MGUS) is two-to three-fold higher with an earlier age of onset of the disease in those of African descent compared to Caucasians (4)(5)(6). United States-based population studies have also indicated a greater overall survival (OS) and disease specific survival (DSS) in patients of African descent when compared to European Americans, suggesting more indolent disease (4,7).…”

“…There is a paucity of data on MM from Sub-Saharan Africa. Prior studies conducted in Kenya have reported on clinicopathologic parameters and patient survival (5,6). However, the plasma cell immunophenotype in a cohort of patients with MM has not been studied previously.…”

Medical practitioners’ knowledge and awareness of multiple myeloma at public hospitals, Gauteng, South Africa

“…Our findings showed that male practitioners were five times more likely to be aware of the MM than females, and this could be because males (61%) made up the majority of the GPs compared to 39% of females, of which GPs are the most common practitioners patients initially consult. 17 , 36 , 37 Our finding also found that participants with six or more years post-medical degrees were aware of MM, which shows that most of the respondents in our study were experienced.…”

Expanding Myeloma Training and Care in Western Kenya Through the ECHO Model: The Pilot Phase

“… 5 Conversely, a modest OS of 29 months was recorded among patients with ndMM receiving treatment in a tertiary hospital in Kenya between 2009 and 2019 where SCT was not available. 6 Late diagnosis which was hypothesized to be a major contributor to the dismal survival observed in Kenya may be attributed, to a large extent, to inadequate skills among primary care teams in Kenya to identify potential patients with myeloma and refer them for specialized care. 7 Innovations that bridge the skills gap between primary health care teams and experts at tertiary centers are therefore desperately needed.…”