Clinical and laboratory characteristics of multiple myeloma in adult patients diagnosed at muhimbili national hospital

The burden of Multiple myeloma varies worldwide, with the highest rates being reported in the most economically developed regions of the world (e.g. Europe, North America, Australia) and the lowest rates in the least developed regions (e.g. parts of Africa, Asia and parts of Latin America). Multiple myeloma is a less frequent cause of cancer among both sexes but it is a major burden and completely changes the life of patients with the disease. Despite these, serious implications with a high risk of loss of renal function, pathological fractures and severe anaemia which may lead to cardiac failure may develop if not treated. However there is no study done in Tanzania which outlines the clinical and laboratory characteristics of Multiple myeloma in our setting. Thus, this study will provide a stepping stone and serve as the basis for future studies. Objective To assess clinical and laboratory characteristics among adult patients with Multiple myeloma at Muhimbili National Hospital. Methodology A hospital based retrospective-cross sectional study was carried out among Multiple myeloma patients aged 18 years and above at Muhimbili National Hospital. 117 Multiple myeloma patients was recruited out of 1809 BMA (Bone marrow aspiration) done from Jan 2010 to Dec 2014 at Heamatology unit. FBC was used to determine WBC,RBCs and platetlets counts, Peripheral blood smear used to determine WBC,RBC and platelets morphology. BMA was used to determine the plasma cells percentage(%), Serum Creatinine was used to determined status of the kidneys function, Serum Calcium used to determine concentration of calcium in the blood; Serum calcium level was not corrected by albumin level. Skeletal survey was used to detect evidence of lytic lesions and/or pathological fractures. SPEP (Serum protein electrophoresis) used to determine M-band which presents the extent of the disease. A questionnaire was used to for data collection. Pre coded data were entered into computer using Ms Excel and the data were transferred to SSPS(Statistical Package for Social Sciences) version 20 for further cleaning categorizing of continuous variables and eventually analysis. Results One hundred and seventeen (117) patients with Multiple myeloma were consecutively sampled from total of 1809 of patients done BMA with various haematological disorders done in 5 years, who attended at haematology unit during the period of data collection. All were of African origin, mean age 56±11.7 and 53% were males and 47% were females. 65% of the patients with Multiple myeloma fall in age group 46 to 65 years. Majority of study subject 92.3% presented with fatigability, followed by bone pain (88%), back pain (67.5%), limb pain (32.48%) and the least symptom was jaw swelling(0.3%). Of 71 study participants who were evaluated for RFTs had high level of Serum Creatinine above normal (> 97µmol/L) (p value=0.87 ). Hypercalcemia occurred in 54 cases (46.2%). The haematological findings showed anaemia which was categorized by WHO criteria into mild (17.9%), moderate (36.8%) and severe (38.5%).The mean value for bone marrow nucleated plasma cells was 41.67±23.46 (p-value 0.56). Conclusion: Males are affected equally to females by 1:1.1 ratio. Majority of patients present with fatigue, bone pain, back pain and limb pain. Elderly patients presenting with anaemia, renal insufficiency (high serum creatinine level) and neurological deficient(back and limb pain lead to weakness of lower limbs|), should give clinician suspicious for Multiple myeloma