BackgroundMultiple myeloma (MM) is one of the hematological malignancies that require palliative care. This is because of the life-threatening nature and the suffering associated with the illness. The aim of this study is to bring to the fore the complications experienced by people living with MM in the Niger-Delta region of Nigeria and the outcome of various palliative interventions.MethodsThis was a 10-year multi-center retrospective study of 26 patients diagnosed and managed in three major centers in the Niger-Delta region of Nigeria from January 2003 to December 2012. Information on the clinical, laboratory, radiological data, and palliative treatment was obtained at presentation and subsequently at intervals of 3 months until the patient was lost to follow-up.ResultThe mean duration from onset of symptoms to diagnosis was 13.12 months (95% CI, 6.65–19.58). A total of 16 (61.5%), eight (30.8%), and two subjects (7.7%) presented in Durie–Salmon (DS) stages III, II, and I, respectively. The complications presented by patients at diagnoses included bone pain (84.6%), anemia (61.5%), nephropathy (23.1%), and hemiplegia (35%). All the patients received analgesics, while 50.0% received blood transfusion, 56.7% had surgery performed, 19% had hemodialysis, and 3.8% received radiotherapy. A total of 10 (38%) patients benefited from bisphosphonates (BPs). A total of 57.6% of patients were on melphalan–prednisone (MP) double regimen, while 19% and 8% patients were on MP–thalidomide and MP–bortezomib triple regimens, respectively. A total of 3.8% of patients at DS stage IIIB disease had autologous stem-cell transplantation (ASCT). Only 7.6% of the myeloma patients survived up to 5 years post diagnosis. The overall mean survival interval was 39.7 months (95% CI, 32.1–47.2).ConclusionLate diagnosis and inadequate palliative care account for major complications encountered by MM patients in the Niger-Delta region of Nigeria. This could be responsible for the poor prognostic outcome and low survival interval of MM individuals in this region. There is, therefore, a need to improve the quality of palliative care received by myeloma patients in this region. This is achievable via provision of relevant and affordable health care facilities for diagnosis and treatment of the disease.

Backgound: Multiple myeloma (MM) is one of the commonest haematological malignancies of public health importance in low-income countries of sub-Saharan Africa. Though primarily a disease of the bone marrow, it often poses a diagnostic dilemma for the orthopaedic surgeons because of the frequent skeletal manifestations. Consequently, misdiagnosis and late presentation are often common contributory factors to the poor prognosis and survival of victims in this environment. This retrospective study aimed at finding out the therapeutic challenges of MM in developing countries such as Nigeria. Methodology: A-10-year multi-centered retrospective analysis of 26 patients diagnosed and managed in three major centers between 2003 and 2013. Informations on the clinical, laboratory, radiological datas and therapeutic interventions were obtained at presentation until patients were lost to follow-up. Result: The median age of diagnosis was 60.6 years with M:F ratio of 2.3:1.(p<0.05). 61.5%, 30.8% and 7.7% presented in Durie Salmon (DS) stages III, II and I diseases respectively. The mean survival interval was 39.2 months (95% CI, 32.0-47.2 months). 84.5% and 8% were on Melphalan plus Prednisolone (MP) and Cyclophosphamide plus prednisolone (CP) combination chemotherapies respectively. The longest survival interval of 80 months was recorded by MP plus Bortezomib (V) triple regimen.There was no significant difference between the outcome of MP and VMP (p=0.33). Conclusion: Triple combination regimens (i.e,VMP, MPT) are superior to standard MP in terms of overall survival (OS),and quality of life of MM patients in developing countries, although this is not statistically significant. Disclosures No relevant conflicts of interest to declare.

Background: According to World Health Organization, Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems, physical, psychosocial and spiritual. Multiple Myeloma (MM) is one of the hematological malignancies that requires palliative care. This is because of the diagnostic dilemma it poses in resource-limited settings, its life-threatening nature and the suffering it inflicts on people living with it, especially in sub-Saharan Africa. Late presentation coupled with the complications of the disease worsen the prognosis of MM in this region, hence the need for palliative intervention. This study gives insight to the complications presented by people living with MM in the Niger-delta region of Nigeria and the outcome of various palliative interventions recruited to improve their quality of life. Methodology: A-10-year multi-centered retrospective analysis of 26 patients diagnosed and managed in three major centers from January, 2003 to December, 2013. Information on the clinical, laboratory, radiological data as well as palliative treatment (supportive and definitive) was obtained at presentation and at 3 monthly intervals until patients were lost to follow-up. Result: The median age of patients was 60.6 years with M:F ratio of 2.3:1. The mean duration before presentation was 11.8 months (11-48 months) with 61.5% (16), 30.8% (8),and 7.7% (2) presenting in Durie-salmon (DS) stage III,II and I diseases respectively. About 65.4% of the patients had a Performance status (PS) of III-IV (based on Eastern Co-operative Oncology Group (ECOG) classification)) while 34.6% had PS of I-II. The complications presented at diagnosis were anaemia (61.5%), pathological fracture (42.0%), nephropathy (23.1%), and hemiplegia (35%). The mean Hemoglobin concentration, Erythrocyte sedimentation rate (ESR), Bone marrow plasma cells (BMPC), serum creatinine, serum calcium and serum albumin were 7.8±5.1g/dl, 126.9±59.0 mm/hour, 38.5±33.5%, 256±192.5µmol/L, 2.51±0.8mmol/L and 36±9.3g/dl respectively. 25% (1/4) and 75% (3/4) were IgA- and IgG-types myeloma respectively. 70% (14/20) had osteopenic bone lesions. All (100%) the patients received analgesics (mainly NSAID regimens-non could access oral morphine) and hematinics (Iron supplements) as supportive interventions while 56.7%, 50.0%, and 19% had surgery, blood transfusion and renal hemodialysis respectively. Radiotherapy, Bisphosphonates, Erythropoietin and G-CSF (Neupogen) were received by 3.8%, 38%, 38%, and 11.4% of the patients respectively. 57.6% were on melphalan-prednisone (MP) double regimen while 19% and 8% were on MP-Thalidomide and MP-Bortezomib triple regimens respectively.8% were on Cyclophosphamide plus Prednisolone (CP). 3.8% at DS stage III-B disease had an Autologous Stem Cell Transplantation (ASCT). The mean survival interval was 13.12 months (95% CI, 6.65-19.58). The patients on MPV had longest duration of 72 months while the patients on CP had least duration of 2 months. Conclusion: The PC of people living with advanced stage MM in Niger-Delta Nigeria is grossly inadequate. This could account significantly for the poor prognostic outcome of MM in the region. There is need to scale up palliative care of people living with MM via proper diagnosis, good supportive and definitive interventions. Oral morphine should be made availabe to alleviate the pains and sufferings due to bone lesions in this condition. Disclosures No relevant conflicts of interest to declare.

Background: Multiple myeloma (MM) is one of the commonest haematological malignancies with orthopaedic complications due to its skeletal related events (SREs) such as chronic bone pain, osteoporosis and pathological fracture. Objective:The objective of this study is to promote the campaign on awareness and periodic screening for MM in the middle-aged to elderly (≥40 years) target group.Methods: This is by systematic review and literature search of evidence-based research articles on MM, especially in sub-Saharan Africa and the theoretical behavioural frameworks to effect the desired change in the target population. This was by translating the three major terms of the research question to the controlled vocabulary of the database. The three terms or keywords used were Health Promotion, Health Campaign and MM. PubMed, Google scholar, Cochran Database Systematic Review, African Journal Online were used as the search database. Results:The expected outcome will be the adoption of the campaign innovations in all perceived susceptible group as evidenced by early screening and treatment. Conclusion:The successful execution of this campaign policy will increase awareness and case ascertainment of MM in the targeted population. The hallmark will be early diagnosis and improved life expectancy of people living with MM in the region.