Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries: A Single-Center Experience From Sri Lanka

Saman Hewamana, Prasanna Gunasena, Chathuri Jayasinghe, Thurairajah Skandarajah, Mahesh Harischandra, Sobitha Abeyaratne, Lalith Ekanayake, Gnani Somasundaram, Surjit Somiah, Vadivelu Srinivasan, Gehan Arseculeratne, Neomal Perera, Jayaindra Fernando, Mazhar Faiz, Nihal Munasinghe, Ashfaq Mowlana, Samadhi Deshapriya, Supun Mawathakubura, Chandana Wickramarathna, Ananda WijewickramaPriyankara Jayawardena, Eranga Perera, Natasha Peiris, Sarath Paranawithane, Chitranganie Perera, Chitranga Kariyawasam, Sanjeewa Munasinghe, Chandu De Silva, Rohini Wadanamby, Geethani Galagoda, Thet Thet Lin, Bandula Wijesiriwardena, Jayantha Balawardena

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Abstract

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.
Original languageEnglish
Article numbere2100352
Number of pages11
JournalJCO Global Oncology
Volume8
Issue number8
Early online date30 Jun 2022
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Creative Commons Attribution Non-Commercial No Derivatives 4.0 License https://creativecommons.org/licenses/by-nc-nd/4.0

Keywords

  • Antineoplastic Combined Chemotherapy Protocols - therapeutic use
  • Bortezomib - therapeutic use
  • Cyclophosphamide - therapeutic use
  • Developed Countries
  • Dexamethasone - therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Myeloma - diagnosis - drug therapy
  • Retrospective Studies
  • Sri Lanka - epidemiology
  • Thalidomide - therapeutic use

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