Multiple myeloma in Niger Delta, Nigeria: complications and the outcome of palliative interventions

Abstract

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.

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

“…In terms of prognosis, the majority of our patients were classified at stage III of the ISS (78.8%). A study published in 2017 by Nwabuko, et al showed the predominance of stage III of the ISS [11]. Our results were different from the European series which reported stage I with a proportion of 32% [17][18][19].…”

“…The deterioration of the general state and bone pain were mainly observed as symptom in respectively 63.3% and 48.5%. These symptoms were found in the Nigerian and Central African studies [11][12][13][14]. This finding was related to the delay of diagnosis of our patients because of low financial means but also the accessibility to a consultation center so that most of our patients are seen late most often at the stage of complications.…”

“…This difference is explained by the fact that our patients consulted late sometimes at the stage of complications due to lack of financial means but also the distance to health centers consultations. Stage III of the ISS is attributed to the independent factor of mortality and associated with a pejorative factor [11,13,20].…”

Multiple Myeloma in Cameroon: Clinico-Biological Characteristics of Patients; an Experience from Douala General Hospital

“…This finding is similar to that reported by recently in Cameroon in the same hospital by Doualla-Bija, et al [14]. Several studies in Nigeria [6,13,15,18] and in the western world by Talamo, et al [12]. The pattern of presentation in our study clearly depicts late presentation as most of the patients presented with one or more complications.…”

“…It is the most common hematologic malignancy among blacks [3,4]. The aetiology of MM remains largely unknown [5], however, recent studies have identified the following factors implicated as potential risk factors of MM, increasing age (>65 years), male gender, black race, positive family history of MM or LHC (genetic influence), and monoclonal gammopathy of undetermined significance (MGUS) [6,7]. MM is usually preceded by a MGUS at a progression rate of 1% per year [8].…”