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

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Purpose of Review

Based on personal experiences, recommendations for physicians treating patients with multiple myeloma (MM) in low- and middle-income countries (LMICs) are proposed.

Recommendations

(1) Implement strategies to keep the patient in the best possible condition for the longest time, in addition to focusing on ways to avoid financial toxicity; (2) if lenalidomide is unavailable, start treatment with thalidomide and dexamethasone, include, if possible, bortezomib; (3) conduct an outpatient-based autologous stem cell transplantation (ASCT) in all eligible patients; (4) use thalidomide as post-ASCT maintenance treatment if lenalidomide is unavailable for the standard risk patients; (5) monitor monoclonal proteins with serum protein electrophoresis and free light chain measurements; (6) employ novel drugs in cases of relapsed or refractory disease; and (7) do not forget supportive therapy.

Summary

The therapeutic recommendations to treat patients with MM are somewhat different for physicians working in LMICs, compared with those treating patients in high-income countries. These are relevant since more than 50% of the inhabitants of the world live in LMICs, thus indicating that the vast majority of patients with MM are being treated in resource-constrained settings. As time goes by, physicians may acquire the ability to analyze and express their feelings and experiences about topics in the practice of medicine in which they could have learned lessons (1). Since 1980, we have been treating patients with multiple myeloma (MM); to date, we have been personally involved in the study and treatment of more than 300 patients with this disease (2). Having gained experience dealing with MM patients in underprivileged circumstances, such as those prevailing in our country: México, having explored different ideas, treatments, and methods, and being aware of the financial implications which may impact our selection of therapeutic strategies and recommendations, we felt that it was appropriate to share in this article some of these ideas with practitioners around the world who are involved in the treatment of patients with MM in low- and middle-income countries (LMICs).

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Acknowledgements

Authors appreciate from Sergio LOZANO-RODRIGUEZ MCP, MWC, the language review of this paper

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Authors and Affiliations

  1. Centro de Hematología y Medicina Interna de Puebla, Clínica RUIZ, Puebla, Mexico

    Guillermo J. Ruiz-Argüelles

  2. Hospital Universitario “Dr. Jose Eleuterio González”, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico

    David Gómez-Almaguer

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  1. Guillermo J. Ruiz-Argüelles
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Correspondence to Guillermo J. Ruiz-Argüelles.

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Ruiz-Argüelles, G.J., Gómez-Almaguer, D. Lessons Learned Treating Patients with Multiple Myeloma in Resource-Constrained Settings. Curr Hematol Malig Rep 16, 40–44 (2021). https://doi.org/10.1007/s11899-021-00616-6

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