10.7.4
Multiple Myeloma
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 10, Oncology.
Clinical Description
- Multiple myeloma (MM) appears to be relatively rare in Malawi, perhaps due to younger population age structure than resource-rich countries and low index of suspicion.
Investigations
- Diagnosis of MM relies on a combination of clinical presentation such as bone pain, morphological examination of bone marrow and basic investigations for the CRAB (calcium, renal disease, anemia and bone disease) criteria for MM by way of determination of calcium levels, renal function, full blood count and X-rays.
- Monoclonal gammopathy should also be demonstrated. Currently, there are no facilities for protein electrophoresis, immunoglobulin quantitation and immunofixation in Malawi.
Treatment
- In terms of MM treatment, prednisone and oral dexamethasone.
- Vincristine, Doxorubicin (infusion) and Dexamethasone (VAD regimen) or a combination of Cyclophosphamide with Prednisone can be given.
- Ideal options include: Lenalidomide, Pomalidomide, Bortezomib, Melphalan if available.
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