Department of Internal Medicine, Joseph Raseta Befelatanana Hospital, Antananarivo, Madagascar.
Oncology Department, Professeur Zafisaona Gabriel Hospital, Mahajanga, Madagascar.
Hematology. 2023 Dec;28(1):2261803. doi: 10.1080/16078454.2023.2261803. Epub 2023 Sep 25.
In Madagascar, the epidemiologic, therapeutic, and evolutionary aspects of multiple myeloma remain poorly understood. Our objectives were to describe the cases, report factors associated with mortality, and estimate patient survival.
This was a retrospective descriptive and analytical study conducted in five teaching hospitals in Madagascar: HJRA and CENHOSOA (Antananarivo), CHUPZAGA (Mahajanga), CHUAT (Toamasina) and CHUT (Fianarantsoa). The study included patients diagnosed with multiple myeloma between January 1, 2010 and December 31, 2021.
Of the 11,374 cancer patients, 75 (0.66%) had multiple myeloma. The mean age of the patients was 59.9 years (±8.9) and the sex ratio was 1.5. Arterial hypertension was observed in 32% of the patients. The most common symptom of myeloma was bone pain ( = 48; 64%). Forty-six patients (61%) were diagnosed with stage III myeloma and 28 patients (37.3%) with stage IIIA myeloma according to the Durie-Salmon classification. Anemia, renal failure, hypercalcemia and fractures were present in 53%, 37%, 21% and 28% of cases, respectively. Fifty-four patients received specific treatment. The combination of melphalan-prednisone-thalidomide was used in 79.63% of cases, and one patient had received autologous stem cell transplantation. Eleven patients (14.67%) died. Chronic kidney disease ( = 0.009), smoking ( = 0.028) and two associated comorbidities ( = 0.035) were associated with mortality. The median overall survival was 45.5 months.
Patient survival is shorter than reported in the literature. The high mortality rate is due to comorbidities and limited access to recommended therapies.
在马达加斯加，多发性骨髓瘤的流行病学、治疗和进化方面仍知之甚少。我们的目的是描述病例，报告与死亡率相关的因素，并估计患者的生存率。
这是一项在马达加斯加五所教学医院进行的回顾性描述性和分析性研究：HJRA 和 CENHOSOA（安塔那利佛）、CHUPZAGA（马任加）、CHUAT（图阿马西纳）和 CHUT（菲亚纳兰楚阿）。该研究包括 2010 年 1 月 1 日至 2021 年 12 月 31 日期间诊断为多发性骨髓瘤的患者。
在 11374 名癌症患者中，有 75 名（0.66%）患有多发性骨髓瘤。患者的平均年龄为 59.9 岁（±8.9），性别比为 1.5。32%的患者患有高血压。骨髓瘤最常见的症状是骨痛（ = 48；64%）。根据 Durie-Salmon 分类，46 名患者（61%）被诊断为 III 期骨髓瘤，28 名患者（37.3%）被诊断为 IIIA 期骨髓瘤。贫血、肾衰竭、高钙血症和骨折分别出现在 53%、37%、21%和 28%的病例中。54 名患者接受了特定的治疗。在 79.63%的病例中使用了马法兰-泼尼松-沙利度胺联合治疗，一名患者接受了自体干细胞移植。11 名患者（14.67%）死亡。慢性肾脏病（ = 0.009）、吸烟（ = 0.028）和两种并存的合并症（ = 0.035）与死亡率相关。总生存中位数为 45.5 个月。
患者的生存时间短于文献报道。高死亡率归因于合并症和推荐疗法的获得受限。
