Management of Multiple Myeloma in Developing Countries

Abstract

Multiple myeloma (MM) is one of the commonest hematological malignancies of public health importance especially in low-income countries (LICs) of Sub-Saharan Africa. The two major challenges in the management of MM in developing countries are in the diagnosis and treatment. It poses diagnostic dilemma to physicians, especially orthopedic surgeons, because of the skeletal related events (SREs). Lack of modern equipment for diagnosis is a key player in late diagnosis of MM, and the management follows a palliative approach in the region. There is a gross inadequacy in the palliative care of MM in developing countries. The definitive treatment still remains melphalan-prednisone (MP) combination regimen as against the standard bortezomib-lenalidomide-dexamethasone (RVD) triplet regimen used in developed countries. Stem cell transplantation is still a far cry in the treatment of MM in the region due to its high cost and unavailability in the region. About 7.6% of MM patients survive up to 5 years postdiagnosis in LICs. This is below estimated 5 years postdiagnosis overall survival of 44.9% recorded by SEER cancer statistics review of 1975–2007 in the USA. This chapter highlights management and some of the diagnostic and therapeutic challenges encountered by people living with MM in developing countries.