Global burden of multiple myeloma: A systematic analysis for the Global Burden of Disease study 2016.

e20023 Background: Multiple myeloma (MM) is a plasma cell neoplasm with substantial morbidity and mortality. A comprehensive description of the global burden of multiple myeloma is needed to help direct health policy, resource allocation, research, and patient care. In this study we describe the burden of multiple myeloma, and the availability of effective therapies for 21 world regions, and 195 countries and territories from 1990 to 2016. Methods: We report incidence, mortality, and disability-adjusted life-years (DALYs) 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 between 1990 and 2016 globally, by Sociodemographic Index (SDI), and by region. We calculated the stem cell transplant to myeloma incidence ratio as an indicator of transplant availability. Results: Worldwide in 2016 there were 138 509 (95% uncertainty interval (UI), 119 064–158 268) incident cases of MM with an age-standardized incidence rate (ASIR) of 2.1 (95% UI, 1.8–2.4). Incident cases between 1990 and 2016 increased by 126% globally and between 106% and 192% for all SDI quintiles. The three world regions with the highest ASIR of MM were Australasia (5.8; 95% UI, 4.4–6.5), North America (5.2; 95% UI, 4.7–6.5), and Western Europe (4.6; 95% UI, 3.7–5.5). MM caused 2.1 million (95% UI, 1.9 to 2.3 million) DALYs globally. The highest stem cell transplant to MM rates were found in Jordan (2.5 transplants per myeloma case), followed by Israel (2.3), Saudi Arabia (2.0), and Singapore (1.6). In 2016 lenalidomide and bortezomib have been approved in 73 and 103 countries, respectively. Conclusions: The burden of multiple myeloma is very heterogeneous by location. However, incident cases increased in all locations. Effective therapy for MM exists and could be delivered in low and middle income (LMIC) countries if availability of these agents was expanded. There is potential to develop fundamental myeloma care programs in LMIC countries.