scholarly journals Management of Multiple Myeloma in Developing Countries

2019 ◽  
Author(s):  
Ogbonna Collins Nwabuko
Keyword(s):  
Multiple Myeloma ◽  
Developing Countries

Thromboprophylaxis in Multiple Myeloma: Indian Perspective

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5207-5207
Author(s):  
Velu Nair ◽  
Satyaranjan Das ◽  
Ajay Sharma ◽  
Deepak Kumar Mishra ◽  
Shilajit Bhattacharya ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Multiple Myeloma ◽  
Developing Countries ◽  
Adverse Effects ◽  
Venous Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Dose ◽  
Low Molecular Weight ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Abstract Background: Hypercoagulability has been observed in patients of multiple myeloma and has been associated with deep venous thrombosis (DVT). There is growing evidence of increased rate of venous thromboembolism associated with use of thalidomide, an anti angiogenesis drug, especially when combined with other agents such as dexamethasone and doxorubicin. Currently there is no consensus on the most appropriate prophylactic approach for thrombotic episodes in patients of multiple myeloma treated with thalidomide containing regimen. Although newer thalidomide derivatives with less thrombogenic adverse effects are being used in the developed countries, in developing countries like India due to financial constraints thalidomide remains the 1st line drug for multiple myeloma. Further there are scant reports of multiple myeloma related thrombosis and thrombo prophylactic regimen from developing countries. Objectives: To evaluate the incidence of symptomatic as well as asymptomatic thrombosis at onset of the disease as well as during treatment, the efficacy of low dose aspirin and low molecular weight heparin as thromboprophylaxis and their adverse effects in multiple myeloma patients treated with thalidomide and dexamethasone regimen. Patients and Methods: 30 patients of multiple myeloma reporting to our centre from May 2006 to March 2008 comprised the study group. Patient with past history of bleeding, thrombocytopenia and deranged coagulation parameters were excluded from the study. The male to female ratio was 3:2. The median age was 56 years (39–70). 23 patients were de-novo and 7 patients were relapse cases. Before starting therapy in addition to diagnostic and prognostic work up, all patients were evaluated for symptomatic as well as asymptomatic DVT with the help of Color Doppler Flow Index (CDFI) study and d-dimer estimation. Patients were randomized to low dose aspirin (Aspirin 150 mg once a day) and low molecular weight heparin (Enoxapirin 40 mg once a day). All patients were administered dexamethasone pulses of 40 mg once a day from day 1 to 4 in each cycle of 28 days. Thalidomide was started at a dose of 100mg once a day and increased to maximum of 400 mg depending on tolerability (median dose 200 mg). None of the patients received erythropoietin. All patients were evaluated for DVT at the beginning of each cycle during the first three cycles. Thromboprophylaxis was administered for first three cycles only. The response to therapy was evaluated at completion of 3rd and 6th cycles. Criteria for response were as previously reported by Blade et al. Results: The overall response (OR) after 3 cycles was 18/30 (60%), complete response (CR)-10/30(33.3%), partial response (PR)-8/30(26.7%) and after 6 cycles was 22/28 (78.5%), CR-16/28(57.1%), PR-6/28(21.4%). 2 patients who had progressive disease after 3 cycles were changed to Bortezumib containing regimen. Out of 30 patients only one patient (3.3%) a 70 yr old male had deep vein thrombosis at diagnosis which was asymptomatic and the diagnosis was based on CDFI findings. One patient on low dose aspirin had one episode of upper GI bleed on 5th day of the first cycle and thromboprophylaxis was stopped. During the follow up, none of the patient had any evidence of symptomatic as well as asymptomatic DVT. Conclusion: This study suggests that the incidence of venous thrombosis in our cohort of patients were much lower than reported from the west. Both low doses Aspirin as well as low molecular weight heparin are effective agents for thromboprophylaxis. The adverse effects were acceptable. Larger trials would be required to confirm these findings.

scholarly journals Survival Outcomes of Double and Triple-Only Combination Anti-Myeloma Chemotherapeutic Regimens on 26 Multiple Myeloma Patients Seen in a Sub-Saharan African Country

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5762-5762
Author(s):  
Ogbonna Collins Nwabuko ◽  
Martin Anazodo Nnoli ◽  
Elizabeth Eneikido Igbigbi ◽  
Dorathy Adaunwa Okoh ◽  
Ijezie Innocent Chukwuonye
Keyword(s):  
Multiple Myeloma ◽  
Developing Countries ◽  
Low Income ◽  
Clinical Laboratory ◽  
Conflicts Of Interest ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Significant Difference ◽  
Sub Saharan ◽  
Survival Interval

Abstract Backgound: Multiple myeloma (MM) is one of the commonest haematological malignancies of public health importance in low-income countries of sub-Saharan Africa. Though primarily a disease of the bone marrow, it often poses a diagnostic dilemma for the orthopaedic surgeons because of the frequent skeletal manifestations. Consequently, misdiagnosis and late presentation are often common contributory factors to the poor prognosis and survival of victims in this environment. This retrospective study aimed at finding out the therapeutic challenges of MM in developing countries such as Nigeria. Methodology: A-10-year multi-centered retrospective analysis of 26 patients diagnosed and managed in three major centers between 2003 and 2013. Informations on the clinical, laboratory, radiological datas and therapeutic interventions were obtained at presentation until patients were lost to follow-up. Result: The median age of diagnosis was 60.6 years with M:F ratio of 2.3:1.(p<0.05). 61.5%, 30.8% and 7.7% presented in Durie Salmon (DS) stages III, II and I diseases respectively. The mean survival interval was 39.2 months (95% CI, 32.0-47.2 months). 84.5% and 8% were on Melphalan plus Prednisolone (MP) and Cyclophosphamide plus prednisolone (CP) combination chemotherapies respectively. The longest survival interval of 80 months was recorded by MP plus Bortezomib (V) triple regimen.There was no significant difference between the outcome of MP and VMP (p=0.33). Conclusion: Triple combination regimens (i.e,VMP, MPT) are superior to standard MP in terms of overall survival (OS),and quality of life of MM patients in developing countries, although this is not statistically significant. Disclosures No relevant conflicts of interest to declare.

Clinical Results of a −80°C Simplified Cryo-Preservation Method.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5015-5015
Author(s):  
Jose R. Borbolla Escoboza ◽  
Manuel A. Lopez-Hernandez ◽  
Marcos E. Garza ◽  
Enrique Baez ◽  
Elvira Trueba ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Developing Countries ◽  
Stem Cell ◽  
Liquid Nitrogen ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Cell Transplant ◽  
Malignant Diseases ◽  
Cell Counts ◽  
Cryopreservation Method

Abstract Introduction: Autologus Stem Cell Transplant (ASCT) has found it’s place in the therapy of some common neoplastic diseases such as lymphoma, Hodgkin’s disease and multiple myeloma, and is still under research in a many other malignant and non-malignant diseases such as autoimmune disorders. One common problem for centers performing these procedures in the developing world is the remote possibility of acquiring the controlled-rate freezing and liquid Nitrogen storage apparatus. Method: We have previously described a simple cryopreservation technique that does not require controlled-rate freezing nor liquid Nitrogen, and only utilizes common hospital equipment (Borbolla, et al. Blood 2000,96;11:1654a). Results: Our group has performed 35 Autologus stem cell transplants in three different hospitals, using this cryopreservation method. All transplants were performed using peripheral blood stem cells obtained by apheresis. Mean CD34+ cell counts before cryopreservation were 2.72 X10^8 (SD:±1.07). Mean number of days between cryopreservation and transplant was 23.31 (SD:±15.66). Mean cell viability using Trypan blue method was 95%. One heavily treated and irradiated patient had engraftment failure. Mean number of days to neutrophil engraftment (ANC&gt;500 cells/μL) was 14.55 (SD:±4.54); and for platelet engraftment (Plt&gt;20,000/μL) was 23.18 (SD:±6.85). Conclusion: Our cryopreservation method is comparable to other more expensive and cumbersome variants. Despite the fact that there is controversy surrounding some new indications for ASCT, some indications are already established and increase significantly the possibilities of a great number of patients to be cured from many malignant diseases such as NHL, Hodgkin’s disease, multiple myeloma, germ cell cancers and Ewing’s sarcoma, among others. While there is no centralized data, the number of ASCT procedures performed in developing countries is known to be staggeringly low. The authors believe that behind these very low numbers, are economic issues and not professional capabilities of our health personnel. With the help of a Humanitarian Service Institution (Rotary International) we are currently working with a hospital in a Caribbean country to help them start performing ASCT using this cryopreservation method. Just as we did in our year 2000 meeting poster, we encourage Hematology departments in developing countries to get in touch with us ([email protected]) in order to arrange for this free technology transfer which will enable them to offer this procedure to their patients.

Proteasome inhibitors as therapeutics

2005 ◽  
Vol 41 ◽  
pp. 205-218
Author(s):  
Constantine S. Mitsiades ◽  
Nicholas Mitsiades ◽  
Teru Hideshima ◽  
Paul G. Richardson ◽  
Kenneth C. Anderson
Keyword(s):  
Multiple Myeloma ◽  
Drug Class ◽  
Proteasome Inhibitors ◽  
Cell Cycle Regulators ◽  
Current State ◽  
Intracellular Mechanism ◽  
Ubiquitin Proteasome ◽  
Proteasome Pathway ◽  
Hodgkin's Lymphomas ◽  
Clinical Research Data

The ubiquitin–proteasome pathway is a principle intracellular mechanism for controlled protein degradation and has recently emerged as an attractive target for anticancer therapies, because of the pleiotropic cell-cycle regulators and modulators of apoptosis that are controlled by proteasome function. In this chapter, we review the current state of the field of proteasome inhibitors and their prototypic member, bortezomib, which was recently approved by the U.S. Food and Drug Administration for the treatment of advanced multiple myeloma. Particular emphasis is placed on the pre-clinical research data that became the basis for eventual clinical applications of proteasome inhibitors, an overview of the clinical development of this exciting drug class in multiple myeloma, and a appraisal of possible uses in other haematological malignancies, such non-Hodgkin's lymphomas.

Bone sialoprotein mRNA and protein expression in human multiple myeloma cell lines and patients

2000 ◽  
Vol 111 (4) ◽  
pp. 1118-1121 ◽  
Author(s):  
A. Bellahcene ◽  
I. Van Riet ◽  
C. de Greef ◽  
N. Antoine ◽  
M. F. Young ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Protein Expression ◽  
Cell Lines ◽  
Myeloma Cell ◽  
Bone Sialoprotein ◽  
Multiple Myeloma Cell ◽  
Human Multiple Myeloma ◽  
Mrna And Protein Expression

Controversies surrounding the clonogenic origin of multiple myeloma

2000 ◽  
Vol 110 (1) ◽  
pp. 240-241 ◽  
Author(s):  
Faith E. Davies ◽  
Andrew C. Rawstron ◽  
Roger G. Owen ◽  
Gareth J. Morgan
Keyword(s):  
Multiple Myeloma
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