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Abdalla Awidi
Farah Qasem
A'sem Abu-Qamar
Batool Aqel
Rand Aladayleh
Ilham Alteerah
Ahmad Magableh
, Hisham Bawa”neh
Feras Al-fararjeh


multiple myeloma, survival, treatment, thalidomide, borezomib



Background and objective: Very scanty reports from the middle east and north Africa (MENA) region have been published on multiple myeloma (MM). Multiple myeloma registry has been established at Jordan University Hospital (JUH) since 2009. In this work we aim to review Multiple Myeloma registry with data from 113 patients who were diagnosed with MM at JUH and analyze their management and course.

Methods: This is a non-interventional, and retrospective analysis of MM registry from 2009-2016 involving 113 patients at JUH. Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS). Overall survival (OS) was analyzed with the Kaplan-Meier method. P value was considered significant if it was (<0.05).

Results: We found no gender difference in this registry. The median age is 62 years. Most patients are ISS stage II and III (36.28% for each). Immunoglobulin type G Kappa is the dominant subtype. Bone pain is the most common presenting symptom. The most common laboratory finding is anemia (45.6%). Most of our patients (85.2%) had received thalidomide and dexamethasone, while only 14.8% received bortezomib, thalidomide, and dexamethasone.

The mean overall survival (OS) in our patients was 74 months, and the median survival was 38 months. Median OS for ISS stage I, II, and III were 96, 46, and 16 months respectively.

Conclusion: MM in a developing country presents a challenging disease compared with that in industrial countries in both the epidemiology and management. An improved road map in the care of MM in these countries is needed. The use of three or four drug combination upfront is warranted. However, this is limited because of the high cost of these drugs. We expect the following decade to show better survival and quality of life for MM patients once these drugs are widely used.




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1-Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC. Multiple myeloma. Lancet. 2009;374(9686):324-39.
2-Becker N. Epidemiology of multiple myeloma. Recent Results Cancer Res. 2011;183: 25-35.
3. Palumbo A, Anderson K. Multiple Myeloma. New England Journal of Medicine. 2011; 364:1046–1060.
4. Kazandjian D. Multiple myeloma epidemiology and survival, a unique malignancy. Semin Oncol. 2016; 43(6): 676–681.
5. Hungria VT, Maiolino A, Martinez G, Duarte GO, Bittencourt R, Peters L, Colleoni G, Oliveira LC, Crusoé E, Coelho ÉO, Pasquini R, Magalhães SM, Nunes R, Neto JV, Faria RM, Souza M, Hamerschlak N, Flantl D, Navarro JR, Conte G, Gomez-Almaguer D, Ruiz-Argüelles G, Durie BG; International Myeloma Working Group Latin America. Observational study of multiple myeloma in Latin America. Ann Hematol. 2017 Jan;96(1):65-72. doi: 10.1007/s00277-016-2866-9. Epub 2016 Nov 5. PMID: 27815724.
6. Nnonyelum ON, Anazoeze MJ, Eunice NO, Emmanuel OO, Stella AT, Marcus AI, Taiwo BM, Olufela KO, Chinawaeze AJ, Orkuma JA, Dalhat GG, Otobo UI. Multiple myeloma in Nigeria: a multi-centre epidemiological and biomedical study. Pan Afr Med J. 2015 Nov 24;22:292. doi: 10.11604/pamj.2015.22.292.7774. PMID: 26966488; PMCID: PMC4769058.
7. Sadia S, Syed M, Saira P, Ali H, Basharat M, Multiple Myeloma: a Retrospective Analysis of 61 Patients from a Tertiary Care Center. Asian Pac J Cancer Prev, 2016; 17 (4), 1833-1835.
8- Jalaeikhoo H, Sharifzadeh M, Rajaeinejad M, Keyhani M, Zokaasadi M. Retrospective Analysis of 345 Multiple Myeloma Cases: An Investigation from 2 Institutions. Arch Iran Med. 2018 Sep 1;21(9):412-417
9-El Husseiny NM, Kasem N, El Azeeim HA, Mattar MW. Multiple myeloma: a descriptive study of 217 Egyptian patients. Ann Hematol. 2014;93(1):141-5
10-Mohammadi L, Harir N, Brahimi M, Moulessehoul S, Bekadja MA. Epidemiological, clinical and pronostic aspects of multiple myeloma eligible for therapeutic intensification followed by autologous hematopoietic stem cell in the Algerian West: report of 147 cases. Tunis Med. 2017 Jun;95(6):415-421.
11-Mseddi-Hdiji S, Haddouk S, Ben Ayed M, Tahri N, Elloumi M, Baklouti S, Hachicha J, Krichen MS, Bahloul Z, Masmoudi H. Gammapathies monoclonales en Tunisie: analyse épidémiologique, immunochimique et étiologique d'une série de 288 cas [Monoclonal gammapathies in Tunisia: epidemiological, immunochemical and etiological analysis of 288 cases]. Pathol Biol (Paris). 2005 Feb;53(1):19-25. French. doi: 10.1016/j.patbio.2004.01.014. PMID: 15620605.
12- P. Moreau, J. San Miguel, P. Sonneveld, M. V. Mateos, E. Zamagni, H. Avet-Loiseau, R. Hajek, M. A. Dimopoulos, H. Ludwig, H. Einsele, S. Zweegman, T. Facon, M. Cavo, E. Terpos, H. Goldschmidt, M. Attal & C. Buske Multiple Myeloma: ESMO Clinical Practice Guidelines
Ann Oncol (2017) 28 (suppl 4): iv52–iv61.

(13) Al-Sayaideh, Ayoub & Nimri, Omar & Arqoub, Kamal & Al-Zaghal, Marwan & Halasa, Wafa. (2016). Cancer Incidence In Jordan - 2012. 10.13140/RG.2.1.1251.6246.
(14) Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc. 2003 Jan;78(1):21-33. doi: 10.4065/78.1.21. PMID: 12528874.
(15) Blimark CH, Turesson I, Genell A, Ahlberg L, Björkstrand B, Carlson K, Forsberg K, Juliusson G, Linder O, Mellqvist UH, Nahi H, Kristinsson SY; Swedish Myeloma Registry. Outcome and survival of myeloma patients diagnosed 2008-2015. Real-world data on 4904 patients from the Swedish Myeloma Registry. Haematologica. 2018 Mar;103(3):506-513. doi: 10.3324/haematol.2017.178103. Epub 2017 Dec 7. PMID: 29217784; PMCID: PMC5830385.
(16) Mohty M, Terpos E, Mateos MV, Cavo M, Lejniece S, Beksac M, Bekadja MA, Legiec W, Dimopoulos M, Stankovic S, Durán MS, De Stefano V, Corso A, Kochkareva Y, Laane E, Berthou C, Salwender H, Masliak Z, Pečeliūnas V, Willenbacher W, Silva J, Louw V, Nemet D, Borbényi Z, Abadi U, Pedersen RS, Černelč P, Potamianou A, Couturier C, Feys C, Thoret-Bauchet F, Boccadoro M; EMMOS Investigators. Multiple Myeloma Treatment in Real-world Clinical Practice: Results of a Prospective, Multinational, Noninterventional Study. Clin Lymphoma Myeloma Leuk. 2018 Oct;18(10):e401-e419. doi: 10.1016/j.clml.2018.06.018. Epub 2018 Jun 25. PMID: 30030033.
(17) Yong K, Delforge M, Driessen C, Fink L, Flinois A, Gonzalez-McQuire S, Safaei R, Karlin L, Mateos MV, Raab MS, Schoen P, Cavo M. Multiple myeloma: patient outcomes in real-world practice. Br J Haematol. 2016 Oct;175(2):252-264. doi: 10.1111/bjh.14213. Epub 2016 Jul 13. PMID: 27411022; PMCID: PMC5096152.
(18) Rifkin RM, Abonour R, Terebelo H, Shah JJ, Gasparetto C, Hardin J, Srinivasan S, Ricafort R, Nagarwala Y, Durie BG. Connect MM Registry: The Importance of Establishing Baseline Disease Characteristics. Clin Lymphoma Myeloma Leuk. 2015 Jun;15(6):368-76. doi: 10.1016/j.clml.2014.12.002. Epub 2014 Dec 11. PMID: 25617035.
(19) Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia. 2014 May;28(5):1122-8. doi: 10.1038/leu.2013.313. Epub 2013 Oct 25. PMID: 24157580; PMCID: PMC4000285.
(20) Riva E, Bove V, Villano F, Mori M, Córdoba C, Noria A, Petruskevicius P, Cardeza A, Díaz L. From guidelines to real world: results from the National Multiple Myeloma Registry in Uruguay on 222 newly diagnosed multiple myeloma patients from 2012 to 2015. Curr Med Res Opin. 2019 Jul;35(7):1197-1203. doi: 10.1080/03007995.2019.1568091. Epub 2019 Feb 8. PMID: 30621522.
(21) Remes K, Anttila P, Silvennoinen R, Putkonen M, Ollikainen H, Terävä V, Sinisalo M, Kananen K, Schain F, Castren-Kortegangas P, Järvinen TM, Pisini M, Wahl F, Dixon T, Leval A. Real-world treatment outcomes in multiple myeloma: Multicenter registry results from Finland 2009-2013. PLoS One. 2018 Dec 5;13(12):e0208507. doi: 10.1371/journal.pone.0208507. PMID: 30517181; PMCID: PMC6281251.
(22) Liwing J, Uttervall K, Lund J, Aldrin A, Blimark C, Carlson K, Enestig J, Flogegård M, Forsberg K, Gruber A, Haglöf Kviele H, Johansson P, Lauri B, Mellqvist UH, Swedin A, Svensson M, Näsman P, Alici E, Gahrton G, Aschan J, Nahi H. Improved survival in myeloma patients: starting to close in on the gap between elderly patients and a matched normal population. Br J Haematol. 2014 Mar;164(5):684-93. doi: 10.1111/bjh.12685. Epub 2013 Dec 9. PMID: 24313224.
(23) Shustik, C., Bergsagel, D. E., & Pruzanski, W. (1976). Kappa and lambda light chain disease: survival rates and clinical manifestations.
(24) Wang L, Jin FY, Li Y, Sun JN, Zhang JJ, Tang R, Zhong YP. IgA Type Multiple Myeloma, Clinical Features, and Prognosis. Chin Med J (Engl). 2018 May 20;131(10):1249-1250. doi: 10.4103/0366-6999.231513. PMID: 29722346; PMCID: PMC5956780.
(25) Nair B, Waheed S, Szymonifka J, Shaughnessy JD Jr, Crowley J, Barlogie B. Immunoglobulin isotypes in multiple myeloma: laboratory correlates and prognostic implications in total therapy protocols. Br J Haematol. 2009 Apr;145(1):134-7. doi: 10.1111/j.1365-2141.2008.07547.x. Epub 2008 Dec 20. PMID: 19120351; PMCID: PMC3644943.

(26) Drayson M, Begum G, Basu S, Makkuni S, Dunn J, Barth N, Child JA. Effects of paraprotein heavy and light chain types and free light chain load on survival in myeloma: an analysis of patients receiving conventional-dose chemotherapy in Medical Research Council UK multiple myeloma trials. Blood. 2006 Sep 15;108(6):2013-9. doi: 10.1182/blood-2006-03-008953. Epub 2006 May 25. PMID: 16728700.
(27) Woo YR, Kim JS, Lim JH, Hwang S, Kim M, Bae JM, Park YM, Min CK, Kim DW, Park HJ. Prevalence and clinicopathologic characteristics of multiple myeloma with cutaneous involvement: A case series from Korea. J Am Acad Dermatol. 2018 Mar;78(3):471-478.e4. doi: 10.1016/j.jaad.2017.08.054. Epub 2017 Nov 6. PMID: 29107338.