Clinical and Biochemical Profile of Monoclonal Gammopathies in Caribbean Patients in a Resource-limited Setting

Background: Multiple myeloma is the most common malignant plasma cell dyscrasia and ranks secondamong primary haematological malignancies. This study describes the epidemiologic, clinical and pathologicprofile of monoclonal gammopathies seen in the University Hospital of the West Indies (UHWI), a tertiarycare referral centre. Materials and
Method: A retrospective analysis of 85 cases diagnosed at UHWI over the5-year period 2003-2007 was conducted. The cases were identified from the bone marrow records as well asthe computerized database of the Medical Records Department. Clinical presentation, family and personalhistory and demographic data were retrieved. Haematological and biochemical results were also analyzed.
Results: There were 85 patients diagnosed with monoclonal gammopathies. The M:F ratio was 1.2:1 and themean age was 65.7±1.3 years. Eighty percent of the patients had skeletal pain and 40% experienced weightloss. Of the patients experiencing bone pain 56.7% had multiple lytic lesions, 26.7% had pathological fracturesand 26.7% had compression fractures. Seventy-four patients (87.1%) had a haemoglobin level <12.0 g/dL with52.9% having values <8.0 g/dL. Renal impairment was evident at diagnosis in 36.5% . Hypercalcemia was seenin 26.5% and hyperuricemia in 45.9%. Of the 79 patients who had serum protein electrophoresis performed,77.2% had at least one monoclonal band and of these 24.6% had a monoclonal protein also present on urineprotein electrophoresis.
Conclusions: The demographic profile in this group of patients is largely similar to otherstudies in predominantly Caucasian populations; however there was a notable increase in prevalence of severedisease at presentation, with the majority of patients presenting at the most advanced stage. It is probable thatthese differences reflect socioeconomic factors and not merely inherent ethnic variation in disease biology.