TY - JOUR
T1 - Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries
T2 - A Single-Center Experience From Sri Lanka
AU - Hewamana, Saman
AU - Gunasena, Prasanna
AU - Jayasinghe, Chathuri
AU - Skandarajah, Thurairajah
AU - Harischandra, Mahesh
AU - Abeyaratne, Sobitha
AU - Ekanayake, Lalith
AU - Somasundaram, Gnani
AU - Somiah, Surjit
AU - Srinivasan, Vadivelu
AU - Arseculeratne, Gehan
AU - Perera, Neomal
AU - Fernando, Jayaindra
AU - Faiz, Mazhar
AU - Munasinghe, Nihal
AU - Mowlana, Ashfaq
AU - Deshapriya, Samadhi
AU - Mawathakubura, Supun
AU - Wickramarathna, Chandana
AU - Wijewickrama, Ananda
AU - Jayawardena, Priyankara
AU - Perera, Eranga
AU - Peiris, Natasha
AU - Paranawithane, Sarath
AU - Perera, Chitranganie
AU - Kariyawasam, Chitranga
AU - Munasinghe, Sanjeewa
AU - De Silva, Chandu
AU - Wadanamby, Rohini
AU - Galagoda, Geethani
AU - Lin, Thet Thet
AU - Wijesiriwardena, Bandula
AU - Balawardena, Jayantha
N1 - Creative Commons Attribution Non-Commercial No Derivatives 4.0 License https://creativecommons.org/licenses/by-nc-nd/4.0
PY - 2022/6
Y1 - 2022/6
N2 - There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. This is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates. A total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%. To our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting.
AB - There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. This is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates. A total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%. To our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting.
KW - Antineoplastic Combined Chemotherapy Protocols - therapeutic use
KW - Bortezomib - therapeutic use
KW - Cyclophosphamide - therapeutic use
KW - Developed Countries
KW - Dexamethasone - therapeutic use
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Multiple Myeloma - diagnosis - drug therapy
KW - Retrospective Studies
KW - Sri Lanka - epidemiology
KW - Thalidomide - therapeutic use
UR - http://www.scopus.com/inward/record.url?scp=85133251861&partnerID=8YFLogxK
U2 - 10.1200/GO.21.00352
DO - 10.1200/GO.21.00352
M3 - Article
C2 - 35772042
AN - SCOPUS:85133251861
SN - 2687-8941
VL - 8
JO - JCO Global Oncology
JF - JCO Global Oncology
IS - 8
M1 - e2100352
ER -
