Global Burden of Multiple Myeloma: A Systematic Analysis for the Global Burden of Disease Study 2016

Abstract

Introduction: Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of MM is needed to help direct health policy, resource allocation, research, and patient care.

Objective: To describe the burden of MM and the availability of effective therapies for 21 world regions and 195 countries and territories from 1990 to 2016.

Design and setting: We report incidence, mortality, and disability-adjusted life-year (DALY) estimates from the Global Burden of Disease 2016 study. Data sources include vital registration system, cancer registry, drug availability, and survey data for stem cell transplant rates. We analyzed the contribution of aging, population growth, and changes in incidence rates to the overall change in incident cases from 1990 to 2016 globally, by sociodemographic index (SDI) and by region. We collected data on approval of lenalidomide and bortezomib worldwide.

Main outcomes and measures: Multiple myeloma mortality; incidence; years lived with disabilities; years of life lost; and DALYs by age, sex, country, and year.

Results: Worldwide in 2016 there were 138 509 (95% uncertainty interval [UI], 121 000-155 480) incident cases of MM with an age-standardized incidence rate (ASIR) of 2.1 per 100 000 persons (95% UI, 1.8-2.3). Incident cases from 1990 to 2016 increased by 126% globally and by 106% to 192% for all SDI quintiles. The 3 world regions with the highest ASIR of MM were Australasia, North America, and Western Europe. Multiple myeloma caused 2.1 million (95% UI, 1.9-2.3 million) DALYs globally in 2016. Stem cell transplantation is routinely available in higher-income countries but is lacking in sub-Saharan Africa and parts of the Middle East. In 2016, lenalidomide and bortezomib had been approved in 73 and 103 countries, respectively.

Conclusions and relevance: Incidence of MM is highly variable among countries but has increased uniformly since 1990, with the largest increase in middle and low-middle SDI countries. Access to effective care is very limited in many countries of low socioeconomic development, particularly in sub-Saharan Africa. Global health policy priorities for MM are to improve diagnostic and treatment capacity in low and middle income countries and to ensure affordability of effective medications for every patient. Research priorities are to elucidate underlying etiological factors explaining the heterogeneity in myeloma incidence.

Figure 1.. Age-Standardized Incidence Rate of Multiple Myeloma

Age-standardized incidence rate of multiple myeloma, both sexes, 2016. ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samo (Formerly Western Samoa).

Figure 2.. Stem-Cell Transplant Rate per 10 Million, 2010

Frequency of transplantation per 10 million people, both allogeneic and autologous transplant in 2010 as reported by Gratwohl et al. ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samo (Formerly Western Samoa).

Figure 3.. Lenalidomide and Bortezomib Approval, 2016

ATG indicates Antigua and Barbuda; BRB, Barbados; COM, Comoros; DMA, Dominica; FJI, Fiji; FSM, Federated States of Micronesia; GRD, Grenada; KIR, Kiribati; LCA, Saint Lucia; MDV, Maldives; MHL, Marshall Islands; MLT, Malta; MUS, Mauritius; TLS, Timor-Leste; TON, Tonga; TTO, Trinidad and Tobago; SGP, Singapore; SLB, Solomon Islands; SYC, Seychelles; VCT, Saint Vincent and the Grenadines; VUT, Vanuatu; and WSM, Samo (Formerly Western Samoa).