Significant differences in access to tests and treatments for multiple myeloma between public and private systems in Latin America. Results of a Latin American survey. GELAMM (Grupo de Estudio Latino Americano de Mieloma Múltiple).

The incidence of multiple myeloma (MM) has increased in the last 20 years, particularly in middle and low-middle income countries. Access to diagnostic and prognostic tests and the availability of effective care is highly variable globally. Latin America represents 10% of the world population, distributed in countries of varied size, population, and socio-economic development. In the last decade, great improvements have been made in the diagnosis and treatment of MM. Applying these advances in real life is a challenge in our region. Local data regarding MM standards of care and outcomes are limited. A survey was carried out among hematologists from 15 Latin American countries to describe access to MM diagnostic and prognostic tests and the availability of effective care options. This study provides real-world data for MM in our region, highlighting striking differences between public and private access to essential analyses and therapeutic options.

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.

Introduction: In the last decade, substantial improvements in the understanding of the biology of multiple myeloma and the development of novel therapeutic options have led to increased response rates, progression free survival and overall survival. In underdeveloped countries, it is a huge challenge to adapt for this evolution, both in diagnostic and therapeutic aspects. Methods: We conducted a retrospective, national analysis of all patients with newly diagnosed multiple myeloma in a recent period. Diagnostic and prognostic evaluation is carried out according to international recommendations in the majority of patients. Results: The clinical presentation at diagnosis is similar to those reported internationally, although with higher rates of anemia and severe renal failure. Most patients were diagnosed in advanced Durie-Salmon stage (80%), with high ISS score (48% ISS 3). Treatment, both in candidates and non-candidates for transplantation, is conditioned by a limited supply of possibilities, scarce availability of new drugs and absence of clinical trials. This determines lower results in response depth and survival. At 32 months, overall survival was 61.8%, with a statistical difference in favor of younger patients, standard-risk MM and those treated with novel drugs. No patient received antibacterial or antifungal prophylaxis while the majority received adequate antiviral prophylaxis. Infections were the main cause of death (29.7%), overcoming the disease itself. Conclusions: This analysis allows us to raise awareness about strengths and weaknesses in our management of MM patients. There is a need to promote earlier detection, improve supportive care and reduce infection mortality. Greater availability of evidence-based recommended treatment options is required. Access to clinical trials is warranted if care is to be improved.