Multiple myeloma treatment in Dakar: Epidemiological, diagnostic, and therapeutic aspects
Dr Nata Dieng - Hôpital Principal de Dakar, Dakar, Senegal
In this poster I wanted to describe the diagnostic profile of our myeloma patients, both with clinical and paraclinical aspects, as well as the treatment they receive and the overall survival.
How common is multiple myeloma in Senegal?
I can’t give you the exact frequency because the studies carried out so far have been sectoral. Myeloma is on the increase in our routine consultation and we observe a prevalence in young adults from the age of 35, perhaps because our population is fairly young. However, a cancer register has recently been set up by the Ministry of Health and a census is in progress.
What are some of the issues faced with treating multiple myeloma in Dakar, and what therapies does your hospital use to treat patients?
We know the treatment of myeloma is constantly evolving with the arrival of bortezomib, a proteasome inhibitor, lenalidomide and recently daratumumab, a monoclonal antibody, all of which are not available in Senegal or when they are they are very expensive and not subsidised. Our patients are treated by the old protocol in Dakar using triple therapy like melphalan, thalidomide and dexamethasone. Just thalidomide is free here with fairly good remission, but often early relapse while elsewhere CAR-T therapy is used with better remission and progression free survival.
We also use sometimes bortezomib when patients can afford it. Here in Senegal haematopoietic stem cell of auto-transplantation is not yet practised but it is in progress.
What diagnostics are there?
Diagnosis involves a range of elements including biology, some samples of which are sent abroad, radiology like X-rays, CT scans and MRIs, bone marrow aspiration or biopsy. Most are available in the capital, not necessarily in the suburbs and they are so expensive. So diagnosis is often not exhaustive and delayed. However, we don’t do genetics like FISH, given the costs of these tests which are important for disease prognosis and for adapting treatment.
When do patients present?
The delay between the first sign and consultation was 75 days, about 2.5 months, and about 87% of patients were symptomatic at diagnosis, due maybe to the lack of technical research, specialists in the suburbs and diagnostics.
What advice do you have for other hospitals in Africa?
First enhance technical research, accessibility of medicines and subsidies, and encourage doctors to specialise in clinical haematology because there are so few of us in Africa. Encourage research and partnership in this field. The last one is to better integrate haematological malignancies into the overall cancer control programme.