Survival Outcomes of Double and Triple-Only Combination Anti-Myeloma Chemotherapeutic Regimens on 26 Multiple Myeloma Patients Seen in a Sub-Saharan African Country

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.