CORRELATION OF DEMOGRAPHIC VARIATIONS WITH STAGING OF MULTIPLE MYELOMA PATIENTS IN THE KURDISTAN REGION OF IRAQ
Banaz M. Safar a, Basil K. Abdulla b, Rawand P. Shamoon c, Mohammed A.Hassan d, Akram M. Mohammed a, Ahmed K. Yassin e, and Najmaddin Khoshnaw a
a KBMS-candidate, Dept. of Hematology, Hiwa Cancer hospital, Sulaymaniyah, Kurdistan Region, Iraq.
b Dept. of Hematology, Hiwa Cancer hospital, Sulaymaniyah, Kurdistan Region, Iraq.
c Dept. of Pathology, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
d Cancer Control Program, Hiwa hospital, Kurdistan Region, Iraq.
e Dept. of Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
Submitted: 15/8/2020; Accepted: 5/6/2021; Published: 21/9/2021
DOI Link: https://doi.org/10.17656/jsmc.10322
Multiple myeloma is a malignant proliferation of a single clone of plasma cells that produces monoclonal proteins. It is one of the most frequently diagnosed haematological malignancies.
To explore the epidemiologic and demographic characteristics of multiple myeloma patients in this area and to study their relationship with the stage of the disease.
Subject and Methods
In this retrospective study, 176 multiple myeloma patients from the three governorates of the Iraqi Kurdistan region were diagnosed from June 2013 to December 2018. Their demographic and clinical characteristics and their laboratory and radiological results were analyzed and correlated with the disease stage.
The patients’ median age at diagnosis was 61 years with a range of 35-89 years. The male to female ratio was 1.37:1. The majority of patients were of low social status from the urban areas. Bone pain was the most common presenting symptom encountered in 79% of patients. At the time of diagnosis, anaemia, pathological fractures, renal impairment, and infections were encountered in 62.55%, 21%, 19.9%, and 4.5%, respectively. At the time of diagnosis, 50.6% of the patients had stage II disease, 36.9% had stage III, and 12.5% had stages I disease. The demographic features did not have any significant relation with the stage of the disease.
Multiple myeloma patients in our locality are younger than what has been so far reported from the western world. Half of our cases presented with stage II disease.
Multiple myeloma; Renal impairment; Pathological fracture; Iraqi Kurdistan.
1. Swerdlow S. H., Campo E., Harris N. L., Jaffe E.S., Pileri S.A., Stein H., et al . WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues.Revised 4th edition. IARC: Lyon 2017.p.243
2. Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. J. (2007). Cancer Statistics, 2007. CA: A Cancer Journal for Clinicians, DOI: 10.3322/canjclin.57.1.43 PMID: 17237035
3. Babette Weksler M.D., Geraldine P Schechter. Wintrobe’s Atlas of Clinical Hematology .2nd ed.Wolter Kluwer,New York ,2017.p.139.
4. Becker, N. (2011). Epidemiology of Multiple Myeloma. Multiple Myeloma, DOI:10.1007/978-3-540-85772-3_2 ,PMID: 21509679. 25–35.
5.kazandjian D.multiple myeloma epidemiology and survival: a unique malignancy.Semin Oncology 2016;43(6):676-681.
6. Kyle, R. A., Gertz, M. A., Witzig, T. E., Lust, J. A., Lacy, M. Q., Dispenzieri, A., Greipp, P. R. (2003). Review of 1027 Patients with Newly Diagnosed Multiple Myeloma. Mayo Clinic Proceedings, 78(1), 21–33. doi:10.4065/78.1.21
7. Rajkumar, S. V. (2016). Multiple myeloma: 2016 update on diagnosis, risk-stratification, and management. American Journal of Hematology, 91(7), 719–734. doi:10.1002/ajh.24402
8. Filonzi, G., Mancuso, K., Zamagni, E., Nanni, C., Spinnato, P., Cavo, M., Bazzocchi, A. (2017). A Comparison of Different Staging Systems for Multiple Myeloma: Can the MRI Pattern Play a Prognostic Role? American Journal of Roentgenology, 209(1), 152–158. doi:10.2214/ajr.16.17219
9. Palumbo, A., Avet-Loiseau, H., Oliva, S., Lokhorst, H. M., Goldschmidt, H., Rosinol, L., Moreau, P. (2015). Revised International Staging System for Multiple Myeloma: A Report from International Myeloma Working Group. Journal of Clinical Oncology, 33(26), 2863–2869. doi:10.1200/jco.2015.61.2267
10. Mark Bustoros, Tarek H. Mouhieddine, Alexandre Detappe Irene M. Ghobrial. Established and Novel Prognostic Biomarkers inMultipleMyeloma.2017;37:548-560.Doi: 10.14694/EDBK_175175. PMID: 28561668.
11. Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5:649-655
12. NR.Ramesh Masthi, Gangaboraiah, and Praveen Kulkarni, An Exploratory Study on Socioeconomic Status Scales in a Rural and Urban Setting, Journal of Family Medicine and Primary care, 2013 Jan-Mar
13. Ferlay, J., I. Soerjomataram, R. Dikshit, S. Eser, C. Mathers, M. Rebelo, et al. 2015. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer 136: E359–E386.
14. Forman, D., F. Bray, D. Brewster, C. Gombe Mbalawa, B. Kohler, M. Pieros, et al. Cancer incidence in five continents Vol. X. IARC.Scientific Publications No. 164.2014.
15. Palumbo A, Anderson. Multiple myeloma. NEnglJMed 2011;364:1046–60. PMID: 21410373.DOI: 10.1056/NEJMra1011442
16.Bladé J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years. Report of 10 cases and review of the literature. Arch Intern Med. 1996 Jul 8;156(13):1463-8. DOI: 10.1001/archinte.1996.00440120125014. PMID: 8678716.
17. Rajabli, N., Naeimi-Tabeie, M., Jahangirrad, A., Sedaghat, S.-M., Semnani, S., & Roshandel, G. (2013). Epidemiology of Leukemia and Multiple Myeloma in Golestan, Iran. Asian Pacific Journal of Cancer Prevention, 14(4), 2333–2336. https://doi.org/10.7314/apjcp.2013.14.4.2333
18. Yikilmaz AŞ, Akıncı S, Silay K, Bakanay SM, Bekiroglu I, Dilek I. Vitamin B12 Level Have Prognostic Significance in Multiple Myeloma Patients. Clin Oncol. 2018; 3: 1434.
19. Ahmed K Yassin. The survival advantage of adding thalidomide compared with chemotherapy only in treating symptomatic myeloma in Kurdistan/Iraq. Iraqi J. Hematology. 2014, .3 (2) 75-84.
20. Ghosh, S., McLaughlin, J. R., Spinelli, J. J., Dosman, J. A., McDuffie, H. H., & Pahwa, P. (2011). Multiple Myeloma and Occupational Exposures. Journal of Occupational and Environmental Medicine, 53(6), 641–646.
21. Wallin, A., & Larsson, S. C. (2011). Body mass index and risk of multiple myeloma: A meta-analysis of prospective studies. European Journal of Cancer, 47(11), 1606–1615. doi:10.1016/j
22. Koessel, S. L., Theis, M. K., Vaughan, T. L., Koepsell, T. D., Weiss, N. S., Greenberg, R. S., & Swanson, G. M. (1996). Socioeconomic Status and the Incidence of Multiple Myeloma. Epidemiology, 7(1), 4–8. doi:10.1097/00001648-199601000-00002
23. Alaa Fadhil Alwan. Survival of patients with multiple myeloma diagnosed at the national centre of haematology in Baghdad. Iraqi Journal of Cancer and Medical Genetics 2014. 7 (2)133-39.
24. Samir H. Almueilo. Renal Failure in Patients with Multiple Myeloma, Saudi Arabia J Kidney Dis Transpl 2015;26(3):482-488.
25. Abdul Hameed, Jamshed Ali, Kiran Munawar, Farah Arshad, Farhana Badar, Neelam Siddiqui Characteristics and outcomes of patients with multiple myeloma: Data from a developing country
Med J Islam Repub Iran. 2018(1 Feb);32.1. https://doi.org/10.14196/mjiri.32.1
26. Lu, J., Lu, J., Chen, W., Huo, Y., Huang, X., & Hou, J. (2014). Clinical features and treatment outcome in newly diagnosed Chinese patients with multiple myeloma: results of a multicenter analysis. Blood Cancer Journal, 4(8), e239–e239. doi:10.1038/bcj.2014.55
27. Yassin A. Clinical and Laboratory Profiles of 109 Patients diagnosed with Multiple Myeloma in Erbil City. JFacMedBagdad 1Jul.2013 .55(2):121-4.
28. Despiégel, N., Touboul, C., Flinois, A., Saba, G., Suzan, F., Gonzalez-McQuire, S., & Bonnetain, F. (2018). Health-Related Quality of Life of Patients with Multiple Myeloma Treated in Routine Clinical Practice in France. Clinical Lymphoma Myeloma and Leukemia. DOI: 10.1016/j.clml.2018.08.019
29. Rifkin, R. M., Bell, J. A., DasMahapatra, P., Hoole, M., Lowe, M., Curran, C.,Romanus, D. (2019). Treatment Satisfaction and Burden of Illness in Patients with Newly Diagnosed Multiple Myeloma. PharmacoEconomics - Open. doi:10.1007/s41669-019-00 . 2020 Sep; 4(3): 473–483.
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