Abstract
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. This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. 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. 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. None.
Highlights
Multiple myeloma (MM), called plasma cell myeloma, is a haematological malignancy characterised by an accumulation of clonal plasma cells in the bone marrow, often associated with the detection of a monoclonal paraprotein in the blood and/or urine
We reviewed clinical records and laboratory data available for consecutive patients diagnosed between January 2002 and December 2016 with symptomatic multiple myeloma according to the 2003 International Myeloma Working Group (IMWG) diagnostic criteria.[17]
Since this observation could be biased by the lower life expectancy in Africans, adjusting the incidence for age would allow for more reliable comparison
Summary
Multiple myeloma (MM), called plasma cell myeloma, is a haematological malignancy characterised by an accumulation of clonal plasma cells in the bone marrow, often associated with the detection of a monoclonal paraprotein in the blood and/or urine. MM is classified among the paraproteinaemias, a spectrum of monoclonal protein-secreting disorders that ranges from a pre-malignant condition known as monoclonal gammopathy of undetermined significance (MGUS) to plasma cell leukaemia. The median age at diagnosis is estimated at 71 years.[2] The incidence of MM is two to three times higher in African-Americans compared to Caucasians, while Asians are infrequently affected.[3] AfricanAmericans have better survival than Caucasian Americans.[4] The aetiology of MM is not well understood; the established risk factors are age, sex, race, obesity, and family history of hematologic malignancy or www.ghanamedj.org Volume 53 Number 1 March 2019
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