Multiple myeloma in Niger Delta, Nigeria: complications and the outcome of palliative interventions.
Multiple myeloma in Niger Delta, Nigeria: complications and the outcome of palliative interventions.
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DOI：
10.2147/cmar.s126136
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发表时间：
2017
影响因子：
3.3
通讯作者：
Nnoli MA
中科院分区：
文献类型：
--
作者：
Nwabuko OC;Igbigbi EE;Chukwuonye II;Nnoli MA
多发性骨髓瘤（MM）是需要姑息治疗的血液恶性肿瘤之一。这是因为这种疾病具有威胁生命的性质和与之相关的痛苦。本研究的目的是将尼日利亚三角洲地区MM患者所经历的并发症和各种姑息性干预措施的结果摆在前面。这是一项为期10年的多中心回顾性研究，纳入了2003年1月至2012年12月期间在尼日利亚三角洲地区的三个主要中心诊断和治疗的26例患者。在就诊时获得临床、实验室、放射学数据和姑息治疗的信息，随后每隔3个月获得一次，直至患者失访。从症状发作到诊断的平均时间为13.12个月（95%CI，6.65-19.58）。共有16例（61.5%）、8例（30.8%）和2例（7.7%）受试者分别处于Durie-Salmon（DS）III、II和I期。患者在诊断时出现的并发症包括骨痛（84.6%）、贫血（61.5%）、肾病（23.1%）和偏瘫（35%）。所有患者均接受镇痛，50.0%接受输血，56.7%接受手术，19%接受血液透析，3.8%接受放疗。共有10例（38%）患者受益于双膦酸盐（BP）。共有57.6%的患者接受美法仑-泼尼松（MP）双联方案，而19%和8%的患者分别接受MP-沙利度胺和MP-硼替佐米三联方案。共有3.8%的DS IIIB期患者接受了自体干细胞移植（ASCT）。只有7.6%的骨髓瘤患者在诊断后存活了5年。总体平均生存期为39.7个月（95% CI，32.1-47.2）。晚期诊断和姑息治疗不足是尼日利亚三角洲地区MM患者遇到的主要并发症。这可能是该地区MM患者预后不良和生存期短的原因。因此，有必要提高该地区骨髓瘤患者接受姑息治疗的质量。这可以通过提供诊断和治疗这种疾病的相关和负担得起的保健设施来实现。
Multiple myeloma (MM) is one of the hematological malignancies that require palliative care. This is because of the life-threatening nature and the suffering associated with the illness. The aim of this study is to bring to the fore the complications experienced by people living with MM in the Niger-Delta region of Nigeria and the outcome of various palliative interventions. This was a 10-year multi-center retrospective study of 26 patients diagnosed and managed in three major centers in the Niger-Delta region of Nigeria from January 2003 to December 2012. Information on the clinical, laboratory, radiological data, and palliative treatment was obtained at presentation and subsequently at intervals of 3 months until the patient was lost to follow-up. The mean duration from onset of symptoms to diagnosis was 13.12 months (95% CI, 6.65–19.58). A total of 16 (61.5%), eight (30.8%), and two subjects (7.7%) presented in Durie–Salmon (DS) stages III, II, and I, respectively. The complications presented by patients at diagnoses included bone pain (84.6%), anemia (61.5%), nephropathy (23.1%), and hemiplegia (35%). All the patients received analgesics, while 50.0% received blood transfusion, 56.7% had surgery performed, 19% had hemodialysis, and 3.8% received radiotherapy. A total of 10 (38%) patients benefited from bisphosphonates (BPs). A total of 57.6% of patients were on melphalan–prednisone (MP) double regimen, while 19% and 8% patients were on MP–thalidomide and MP–bortezomib triple regimens, respectively. A total of 3.8% of patients at DS stage IIIB disease had autologous stem-cell transplantation (ASCT). Only 7.6% of the myeloma patients survived up to 5 years post diagnosis. The overall mean survival interval was 39.7 months (95% CI, 32.1–47.2). Late diagnosis and inadequate palliative care account for major complications encountered by MM patients in the Niger-Delta region of Nigeria. This could be responsible for the poor prognostic outcome and low survival interval of MM individuals in this region. There is, therefore, a need to improve the quality of palliative care received by myeloma patients in this region. This is achievable via provision of relevant and affordable health care facilities for diagnosis and treatment of the disease.