Lessons Learned Treating Patients with Multiple Myeloma in Resource-Constrained Settings.

Area of Science:

• Hematology
• Oncology
• Global Health

Background:

• Multiple myeloma (MM) affects a significant global patient population, with the majority residing in low- and middle-income countries (LMICs).
• Treatment strategies in resource-constrained settings require adaptation due to financial toxicity and drug availability challenges.
• Personal clinical experience treating over 300 MM patients in Mexico informs these recommendations.

Purpose of the Study:

• To propose practical, experience-based recommendations for managing multiple myeloma (MM) in resource-limited LMIC settings.
• To address the unique challenges faced by physicians in LMICs, including financial toxicity and drug accessibility.
• To optimize patient outcomes and quality of life for MM patients in LMICs.

Main Methods:

• Review of personal clinical experience and treatment strategies for multiple myeloma over several decades.
• Analysis of therapeutic options considering drug availability (e.g., lenalidomide vs. thalidomide, bortezomib).
• Emphasis on outpatient-based autologous stem cell transplantation (ASCT) and post-ASCT maintenance.

Main Results:

• Prioritize patient condition and minimize financial toxicity in MM management.
• Utilize thalidomide and dexamethasone, potentially with bortezomib, if lenalidomide is unavailable.
• Recommend outpatient ASCT for eligible patients, with thalidomide as potential post-ASCT maintenance.
• Monitor disease progression via serum protein electrophoresis and free light chains; employ novel drugs for refractory cases and ensure supportive care.

Conclusions:

• Adapted therapeutic recommendations are crucial for effective multiple myeloma management in LMICs.
• Strategic use of available agents like thalidomide and bortezomib, alongside ASCT, can improve outcomes.
• Addressing financial toxicity and ensuring supportive care are paramount for MM patients in resource-constrained environments.