Multiple myeloma: The burden and clinico-laboratory characteristics in a Nigerian foremost tertiary hospital

Abstract

Objectives: To determine the burden, the clinical and laboratory pattern of presentation of multiple myeloma (MM) in Ibadan, South-Western Nigeria. Materials and Methods: A retrospective study of cases of MM from December 2007 to November 2012. Results: Records of 21 cases of MM were retrievable. The median age was 60 years, with age range of 40-95 years. The M:F ratio was 1.1:1. IgG MM was the most common, found in 14 (70%). Most cases were referred from other clinical departments of the University College of Hospital with Orthopaedics department referring the highest number (33.3%). The most common complaint included low back and waist pain in 20 (96%) of which 9 (44%) had difficulty in walking but 4 (19%) actually had demonstrable paraparesis. Two cases (9.6%) presented in unconscious state while a case (4.3%) respectively presented with malignant pleural effusion, sacral plasmacytoma and cauda-equina syndrome. The mean hematocrit, white cell count and platelet count were 26.5%, 6, 216/mm 3 and 264, 778/mm 3 respectively. Biochemical abnormalities included hyperuricemia (>6 mg/dl) in 4/15 (26.6%). Uremia (urea 50-200 mg/dl) was found in 4/21 (19%), hypocalcemia (Ca ++ 100 mm/H) values were recorded in 19 (90.5%). Main Radiological features were osteolytic lesions and osteoporosis in 18 (85.7%). Serum protein electrophoretic pattern showed abnormally thick gamma band in 47.1%, thick beta band in 19.1%, marked polyclonal gammopathy in 1 (4.8%) and 4 (18.4%) had nonsecretory MM. Bone marrow studies showed presence of abnormal plasmacytosis in all ranging from 20% to 80% infiltration. Therapy was mainly by combination of melphalan, prednisolone and thalidomide (M + P + T). Those who had thalidomide appear to have better survival. Conclusion: MM is a heterogeneous disease with diverse clinical and laboratory features. An average of 4 cases presented per year; bony presentations predominate, IgG MM was the commonest and hypercalcemia was not documented.