Background : Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. Objective : This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. Methods : A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. Results : Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of symptoms, which included bone pain (96%), anaemia (67%), weight loss (55%) and fractures (44%). Myeloma-related tissue impairment included hypercalcaemia (36%), renal impairment (33%), severe anaemia (52%) and osteolytic lesions (76%); 51.3% of patients were diagnosed in ISS Stage III. Median survival was 33 months; 1-year and 5-year overall survival were 51.6% and 15.5%, respectively. Neither the age at diagnosis nor the duration of symptoms prior to diagnosis correlated with prognosis. Median survival improved with early ISS stage, haemoglobin >8g/dL, plasmacytosis <20%, and normal creatinine and calcium levels. Conclusion : Early onset and late stage presentation are common at diagnosis of MM patients in Ghana, but do not affect survival. Studies into genetic associations are recommended. Funding : None Keywords : Multiple Myeloma, Ghana, Africa, survival, presentation

/pdf/presentation-and-survival-of-multiple-myeloma-patients-in-4oyvexerif.pdf

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

PURPOSETreatment 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, l...

/pdf/retrospective-analysis-of-presentation-treatment-and-1ypskmpks4.pdf

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

Background: There is lack of data on clinical, epidemiological and therapeutic factors that influence optimal clinical response in patients treated for multiple myeloma in Cameroon. Aims and Objectives: To evaluate the response of Cameroonian subjects to the treatment of multiple myeloma and to investigate the factors affecting treatment outcomes. Study Design: The study was a retrospective cohort, descriptive and cross-sectional study. Setting: We recruited participants from three reference hospitals in the town of Yaounde, the capital of Cameroon (Yaounde Central Hospital, Yaounde General Hospital and the Yaounde University Teaching Center). Materials and Methods: Medical records of patients followed up in the hematology units of these hospitals were reviewed and only those with complete clinical, biological and radiological information were included in the study. Relevant data from the files were collected using designed forms. The forms were handed over to a statistician for statistical analysis. Statistics: Quantitative variables were described using measures of central tendency and qualitative variables were described using percentages and numbers. Univariate analysis with the goal of determining the relationship between sociodemographic, clinical, paraclinical factors and clinical response. For multivariate analysis, we employed the Cox model. Statistical significance was set at p < 0.05. Results: A total of 48 patients were recruited for our study, 75% of whom were men (sex ratio of 3:1). The mean age of the participants was 56.23 ± 8 years. Myeloma secreting IgG was found in 47.9% of patients and the mean bone marrow plasmocytosis at the time of diagnosis was 34.3%. Many participants (72.9%) were diagnosed at stage III of the disease. Treatment regimens in use amongst our participants were melphalan – prednisone (52.1%), vincristine – melphalan – cyclophosphamide – prednisone (18.8%), melphalan – prednisone – thalidomide (14.6%), vincristine – doxorubicin – dexamethasone (8.3%), cyclophosphamide – doxorubicin – vincristine – prednisone (6.3%). Overall therapeutic response rate was 45.8% and median survival without disease progression was 301 days. Melphalan – prednisone – thalidomide protocol had the best response (response rate of 71.4%). Factors associated with good clinical response were CRP less than 6 mg/l (p = 0.01) and greater than 6 treatment cycles (p = 0.003). Factors associated with shorter duration of survival without disease progression after treatment were CRP higher than 6 mg/l (p = 0.028), ESR higher than 50 mm/hour (p = 0.048), serum protein levels higher than 80 mg/l (p = 0.0286) and platelet count less than 150000/μl (p = 0.034). However, multivariate analysis revealed that only CRP less than 6mg/l was associated with duration of survival without disease progression (p = 0.018). Conclusion: Response to therapy for multiple myeloma in the Cameroonian subject is lower than that described in scientific literature. Conventional chemotherapy is the most employed in our context. The best therapeutic response was observed with the melphalan-prednisone-thalidomide regimen and CRP was the sole predictive factor of the type and duration of therapeutic response.

Predictive factors of therapeutic response in multiple myeloma in the Cameroonian subject: A multicentric study in Yaoundé

Background: Malignant musculoskeletal tumours are comparatively rare tumours and delays in diagnosis and treatment are common. Understanding the factors that influence delay is important so as to improve the outcomes for cancer patients. Aim: To describe factors associated with delay in presentation of patients with primary musculoskeletal tumours. Study Design: Descriptive cross-sectional study. Setting: The study was conducted in a tertiary referral hospital from July to December 2014. Original Research Article Naomi et al.; JAMMR, 32(23): 107-119, 2020; Article no.JAMMR.62730 108 Methodology: 56 patients with a confirmed histopathological diagnosis of a primary malignant musculoskeletal tumour and who had consented to the study were included. Data was collected using a pre-tested questionnaire. The clinical findings, laboratory results and radiographs of the lesions and the chest, as well as histopathological results were used to stage the musculoskeletal tumour. Data was analyzed using SPSS software version 20.0. Univariate and bivariate analysis was done for associations and results presented in the form of tables, pie charts and bar graphs. Results: A total of 56 patients were studied, 34 (60.7%) males and 22 (39.3%) females with a male to female ratio of 1.5:1. 73.2% (41) of the patients were adults while children comprised 26.8% (15). The age range was 4yrs-78yrs, with a mean of 32.25yrs. The mean patient delay was four months with 50% (28) of the patients seeking care for the first time after three months. Males were twice as likely to present late compared to females (OR 2.5, P=0.10) while patients younger than 40 years were more likely to present late (OR 1.4, P=0.59). Low educational level (OR 3.7, P=0.15) and low family income (OR 2.3, P=0.38) were associated with delayed presentation. Conclusion: Delayed presentation of patients with MS tumours is influenced by a multitude of factors ranging from the socio-demographics (age, sex, education level), socio-economic status and tumour knowledge, beliefs and perception.

/pdf/determinants-of-delayed-presentation-of-patients-with-2a1ztjr0bg.pdf

Determinants of Delayed Presentation of Patients with Primary Malignant Musculoskeletal Tumours Managed in a Tertiary Referral Hospital

/pdf/multiple-myeloma-in-cameroon-clinico-biological-4viuho7kf5.pdf

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

Background : very little is known about musculoskeletal features of multiple myeloma (MM) in Africa. Objectives : To describe the musculoskeletalfeatures of multiple myeloma at presentation in a tertiary health care centre in sub-Saharan Africa. Design : A Cross sectional observational study. Setting : The Douala General Hospital, Cameroon from 2007 to 2013. Subjects : A patient was said to have MM according the current international consensus criteria for diagnosis and staging of MM. Patients with monoclonal gammopathy of undetermined significance, solitary plamocytoma and other haematologic malignancies were excluded. Results : A total of 62 patients were diagnosed with multiple myeloma, 63% were female. Mean age was 57± 12,1 (19-81) years. Musculoskeletal presentation included spine bone pains (75.6%); vertebral fracture with spinal cord compression in 46.8 %. Other clinical features at presentation included anaemia (70.93%), and nephropathy (17.74%). The average percentage of bone marrow plasmacytosis at diagnosis was 33% and Immunoglobulin G was found in 86% of patients. Sixty three per cent of patients were diagnosed at stage III of the disease. Conclusion : Presence of bone pain and anaemia should alert the clinician to investigate along the lines of multiple myeloma. Majority of the patients have osteolytic lesions and pathologic fractures at the time of diagnosis.

/pdf/musculoskeletal-presentation-of-multiple-myeloma-at-general-4e3nub1tsb.pdf

Musculoskeletal presentation of multiple myeloma at general hospital douala, cameroon.

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Musculoskeletal presentation of multiple myeloma at general hospital douala, cameroon.