Predictive factors of therapeutic response in multiple myeloma in the Cameroonian subject: A multicentric study in Yaoundé
Journal Title: The Journal of Medical Research - Year 2018, Vol 4, Issue 2
Abstract
Background: There is lack of data on clinical, epidemiological and therapeutic factors that influence optimal clinical response in patients treated for multiple myeloma in Cameroon. Aims and Objectives: To evaluate the response of Cameroonian subjects to the treatment of multiple myeloma and to investigate the factors affecting treatment outcomes. Study Design: The study was a retrospective cohort, descriptive and cross-sectional study. Setting: We recruited participants from three reference hospitals in the town of Yaounde, the capital of Cameroon (Yaounde Central Hospital, Yaounde General Hospital and the Yaounde University Teaching Center). Materials and Methods: Medical records of patients followed up in the hematology units of these hospitals were reviewed and only those with complete clinical, biological and radiological information were included in the study. Relevant data from the files were collected using designed forms. The forms were handed over to a statistician for statistical analysis. Statistics: Quantitative variables were described using measures of central tendency and qualitative variables were described using percentages and numbers. Univariate analysis with the goal of determining the relationship between sociodemographic, clinical, paraclinical factors and clinical response. For multivariate analysis, we employed the Cox model. Statistical significance was set at p < 0.05. Results: A total of 48 patients were recruited for our study, 75% of whom were men (sex ratio of 3:1). The mean age of the participants was 56.23 ± 8 years. Myeloma secreting IgG was found in 47.9% of patients and the mean bone marrow plasmocytosis at the time of diagnosis was 34.3%. Many participants (72.9%) were diagnosed at stage III of the disease. Treatment regimens in use amongst our participants were melphalan – prednisone (52.1%), vincristine – melphalan – cyclophosphamide – prednisone (18.8%), melphalan – prednisone – thalidomide (14.6%), vincristine – doxorubicin – dexamethasone (8.3%), cyclophosphamide – doxorubicin – vincristine – prednisone (6.3%). Overall therapeutic response rate was 45.8% and median survival without disease progression was 301 days. Melphalan – prednisone – thalidomide protocol had the best response (response rate of 71.4%). Factors associated with good clinical response were CRP less than 6 mg/l (p = 0.01) and greater than 6 treatment cycles (p = 0.003). Factors associated with shorter duration of survival without disease progression after treatment were CRP higher than 6 mg/l (p = 0.028), ESR higher than 50 mm/hour (p = 0.048), serum protein levels higher than 80 mg/l (p = 0.0286) and platelet count less than 150000/µl (p = 0.034). However, multivariate analysis revealed that only CRP less than 6mg/l was associated with duration of survival without disease progression (p = 0.018). Conclusion: Response to therapy for multiple myeloma in the Cameroonian subject is lower than that described in scientific literature. Conventional chemotherapy is the most employed in our context. The best therapeutic response was observed with the melphalan-prednisone-thalidomide regimen and CRP was the sole predictive factor of the type and duration of therapeutic response.
Authors and Affiliations
Chetcha Chemegni Bernard, Douanla Melachio Pélagie Bertille, Tayou Claude, Ashuntantang Gloria, Ngandeu Singoue Madeleine
Keywords
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- EP ID EP523664
- DOI 10.31254/jmr.2018.4204
- Views 97
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