Abstract
Introduction: Multiple myeloma remains to be an incurable hematologic entity, but with the advent of novel agents more patients experience significantly longer survival. In a third world country like the Philippines, autologous bone marrow transplant after chemotherapy for newly diagnosed cases which is the standard of care is difficult to comply. The management paradigm for myeloma has shifted over the years, hence this study. Objective: Determine the clinical profile and treatment outcome of Filipino multiple myeloma patients diagnosed and managed at a tertiary institution from January 2013 to December 2018. Methodology: Retrospective, observational and cross-sectional study of eligible symptomatic myeloma patients. Results: Data for six years were retrospectively collected from a single tertiary institution. The clinical characteristics at diagnosis, treatment and survival rates of 109 active myeloma patients were described. The median age was 61 years (range, 28–83), with 51.4% being female. Median overall survival was 49.5 months (95% CI 42.7–56.2). The frontline treatments of patients were also analyzed. The combined deep response (complete and very good partial) of our patients at 31.7% was higher than of Asian Myeloma Network Study at 30.9%. None of them yet underwent autologous bone marrow transplantation as of date. Novel agents, especially bortezomib was used in 35.7% and significantly affected overall and progression-free survivals when used as a first line treatment. Conclusion: This retrospective analysis demonstrated the paradigm shift in the treatment modality of myeloma and the survival outcomes has significantly improved, especially on the best response to chemotherapy. Short of the ideal management in a third world country like the Philippines, we can now set our new standard of care based on the treatments available including novel agents like bortezomib, and the best practices that our institution offers. Keywords: Multiple Myeloma, Profile, Outcomes, Tertiary
Highlights
Multiple myeloma remains to be an incurable hematologic entity, but with the advent of novel agents more patients experience significantly longer survival
Short of the ideal management in a third world country like the Philippines, we can set our new standard of care based on the treatments available including novel agents like bortezomib, and the best practices that our institution offers
Serum-free light chain analysis is recommended as part of the initial workup for patients suspected of having MM.[2]
Summary
Multiple myeloma remains to be an incurable hematologic entity, but with the advent of novel agents more patients experience significantly longer survival. In a third world country like the Philippines, autologous bone marrow transplant after chemotherapy for newly diagnosed cases which is the standard of care is difficult to comply. Multiple Myeloma (MM) is a malignancy of the terminal differentiation of B cells, associated with. The disease is further defined as symptomatic or active.[1] MM is diagnosed based on the results of bone marrow biopsy and serum protein electrophoresis (SPEP) and/or urine protein electrophoresis (UPEP). Serum-free light chain (sFLC) analysis is recommended as part of the initial workup for patients suspected of having MM.[2] The International Myeloma Working Group (IMWG) defines the diagnostic criteria for active multiple myeloma.[3] (see Appendix A). The Durie Salmon System [4] or the International Staging System [5] (ISS) is used for grading and prognostication of the disease (see Appendix B)
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