Clinico-pathological profile and treatment of multiple myeloma at Kenyatta National Hospital

Abstract

Background Multiple Myeloma (MM) is a chronic B-cell malignancy that involves proliferation of neoplastic clonal plasma cell in the bone marrow with circulating monoclonal immunoglobulins or constituent chains in serum and urine. It is a rare cancer with a lifetime risk of 0.76% and an age-adjusted incidence rate of 2.5-7.2 per 100,000 in high-income countries. There is a paucity of local data on the morbidity of MM. Study Objective To describe the pathological and clinical features, including myeloma defining events, and treatment of MM patients seen at KNH between 2014 and 2018. Methods This was a single centre descriptive retrospective study conducted at the medical records department at KNH. The study population included patients with a documented diagnosis of MM managed as an outpatient or inpatient between 1st January 2014 and 31st December 2018. Demographic data, pathology reports, laboratory results and clinical findings were transcribed and uploaded to a database. Data Analysis Analysis was done using Stata 16® software. Exploratory data analysis was done to identify missing values, check the skewness and normality of the data and to check significant associations. A multivariable cox regression model was used to test the association between presence of anaemia, renal dysfunction and hypercalcemia, and risk of mortality. Results A total of 207 patient files were included in the study. The median age at presentation was 60 years with a slight male preponderance. Bone pain was the predominant complaint in 59% (139/207) of patients, with 17% of patients with paraparesis or paraplegia at presentation. For patients who underwent imaging, osteolytic bone lesions were identified in 90.6% (126/139). Anaemia was present in 71% (147/207) patients, hypercalcemia in 55.4% and renal dysfunction in 38.2%. There were 27 different treatment regimens prescribed, most commonly the older-generation IMID, thalidomide and dexamethasone in 24.5% (45/184), with only 11 patients (6%) on bortezomib-based triplet therapy. Conclusion MM in KNH is a disease of the middle aged, affecting men and women almost equally and presenting mainly with bone pains and anaemia. Though there seems to be a general improvement in diagnosis and care, access to less toxic novel agents for treatment is still wanting.