Epidemiological Data from the Algerian Multiple Myeloma Registry (AMMR) over 2 Years (June 2014-June 2016): Report of the Algerian Multiple Myeloma Study Group (GETMA)

Introduction: Multiple myeloma (MM) is the second hematological malignancy in Western countries with varying incidence across countries and ethnicities. In France, the incidence rate in 2012 is 4.2 in men and 2.0 in women, in USA it is 5.6 but in the population of African origin it is 11.1. In Maghreb, the incidence is 1,1 in Algeria and Morocco and 1.4 in Tunisia in 2004. Although epidemiological transition has taken place in our country, the results of epidemiological data on cancers in general and hematological malignancies in particular are remarkably different from those described in the Western literature.

Aims : Two epidemiological approaches were carried out in Algeria, the first covering a period of 12 years (1995-2005) and the second of 2006-2012, the incidence of MM was the same of 1.1 and 1.01 respectively. These were retrospective studies with the limitations of this type of study, hence the need to create a register that would collect the data in a prospective and real-time manner. This register, known as AMMR (Algerian Multiple Myeloma Registry) belongs to the SAHTS (Algerian Society of Hematology), was created in 2014 after obtaining the approval of the Ministry of Health. The objectives of this register are:

- Obtain reliable epidemiological data

- Describe the profile of Algerian patients (pts)

- To have an analysis of the diagnostic approaches in all the hematology departments

- And measure diagnostic and prognostic difficulties.

The AMMR is a prospective, observational, multicenter study.

Materials and methods: With the support of a contracted clinical research company, we developed a 19 pages case report form (CRF) which registered all newly pts with MM, plasmocytomas. The main registered variables at diagnosis are patient demographics, disease characteristics, complications, biology, imaging, diagnosis, prognosis and only one item on treatment. All hematology services (17) participated in the study with the help of 23 investigators to inform the CRF. The diagnostic criteria used are those of the IMWG 2003, the prognosis is evaluated according to the classification of Salmon and Durie and the International Staging System.

Results: Thus, 1010 pts are collected during these 2 years, 505 men and 505 women. The median age is 63 years (29-100 years), 53% are under 65 years, 13% under 50 years and 18% more than 75 years old. The age-standardized incidence rate (world population WHO 2000-2025) of MM for the year 2015 is 1.71 / 10⁵ inhabitants (1.75 for men and 1.68 for women). In this series: 975 pts (96.53%) are secreting MM and 20 non-secretory MM(1.98%), 4 plasmocytoma (0.40%) and 2 plasma cell leukemias (0.20%). According to the geographical distribution, 62% of the patients are in the middle of Algeria, 19% of the western region and 19% of the eastern region. Among the risk factors for the occurrence of MM, a MGUS is found in 16 pts, a professional activity at risk in 96 pts of which 57 workers of the earth. The clinical feature at diagnosis is dominated by bone syndrome since 92% have bone symptoms, pain in 80.4% of cases and pathological fractures for 96 pts (12%). Neurological signs related to medullary compression are described in 89 pts, anemia is the second complication (56% of the pts). Biological characteristics, the immunological type are IgG type in 50.67% of cases, IgA in 26.36%, light chains in 21.64% of the secreeting MM. All the pts are classified according to the classification of Salmon and Durie, 82% are stages III and 13% of the stages II, among them 24% are classified B. The ISS classification is used in 72% of the pts, with 16.21% stage I, 18.56% stage II and 36.92% stage III. Flow cytometry is performed only in 45 pts (4.5%) and cytogenetics in only one patient.

Comments and conclusion: This study shows that the number of pts with MM is important in our country: more than 1000 in 2 years, whereas the previous data did not exceed 350 pts/year. The median age is 63 years, with 53% under 65 years candidates for therapeutic intensification. On the other hand the incidence is 1.71 higher than the two previous studies; this is explained by the rigor of the prospective studies but not by an increase of the frequency. The data collected still show pts diagnosed later (82% stage III) with complications. We deplore the lack of genetics study for our pts. The AMMR is the first hematological malignancy registry in Algeria, is a reliable data bank, which will allow us to claim more diagnostic, pronostic assessment and care for our pts.