Submit Manuscript | http://medcraveonline.com Introduction Multiple myeloma (MM) is a cancer of plasma cells of blood in bone marrow which leads to overproduction of aberrant immunoglobulin in the blood, a condition known as paraproteinemia. It is one of the commonest hematological malignancies of public health importance in low-income countries of sub-Saharan Africa. It accounts for 10%- 15% of all lymphohematopoietic cancers, 1% of all cancer diagnosis and 0.9%-2% of all cancer-related deaths globally. 1 It accounts for about 8.2% of hematological malignancies in Nigeria. 2 The two major challenges in the management of MM in Nigeria are in the diagnosis and treatment. The duo is majorly responsible for the complications, poor prognosis and survival outcome of people living with MM in Nigeria. Method This article highlights some of the diagnostic and therapeutic challenges encountered by people living with multiple myeloma in Nigeria. A systematic literature search was carried out in Google, MEDLINE, PubMed, and the African Journals online (AJOL) database, with the aim of identifying relevant challenges in the diagnosis, staging, supportive and defnitive therapeutic management of MM in Nigeria. The information was based on peer-reviewed articles published before December, 2017. Results and discussion Aetiology, diagnosis and staging of MM in Nigeria The aetiology of multiple myeloma is unknown. However, Alexander (2007) experience as cited in Nwabuko et al., 3 identifed factors implicated as “potentially etiologic multiple myeloma risk factors”. These factors include increasing age (>65years), male gender, black race, positive family history of multiple myeloma and the hypothesized precursors of multiple myeloma (i.e., Solitary Multiple Myeloma). Based on recent study in Nigeria, Africa’s most populous black nation, the median age of diagnosis of Multiple myeloma was 59.9 years (45-78 years) 4 while the male to female ratio was 2.3:1. 5 However, there is paucity of study on the hypothesized precursors of multiple myeloma in Nigeria. The diagnosis of multiple myeloma is based on a constellation of hematologic, immunologic, histologic, and radiographic features. A minimum of two major criteria, or one major criterion plus one minor criterion, or three minor criteria is used in making diagnosis of MM. 6 The major criteria are plasmacytoma on tissue biopsy, bone marrow infltration with >30% BMPCs, monoclonal globulin spike on serum electrophoresis while the minor criteria include bone marrow infltration with 10-30% BMPCs, paraprotein less than the defned quantity for major criteria and lytic bone lesion. The Table 1 below shows the criteria for diagnosis of MM. According to Nwabuko et al., 4 “though primarily a disease of the bone marrow, it often poses a diagnostic dilemma for the orthopedic surgeons because of the frequent skeletal manifestations”. It is usually misdiagnosed as an orthopedic disease when in the actual sense it is a hematologic disease with orthopedic complications. At advanced stage, it causes multiple lytic bone lesions with severe osteoporosis and pathological fracture. A previous observational study has shown that about 84.6% of newly diagnosed multiple myeloma patients in Nigeria present with multiple bone lesions, and end up with the orthopedic doctors, who may not suspect MM at the initial stage. 3 The key players of the bone lesions in MM are cytokines namely IL-6 (Interleukin-6), TNF- alpha (Tumor Necrosis factor), VEGF (Vascular Endothelial Growth Hematol Transfus Int J. 2018;6(4):155‒157. 155 ©2018 Nwabuko. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. Multiple myeloma and the challenges of its management in Nigeria Volume 6 Issue 4 - 2018 Ogbonna Collins Nwabuko 1,2 1 Department of Hematology, Federal Medical Center, Nigeria 2 Department of Hematology, Abia State University, Nigeria Correspondence: Ogbonna Collins Nwabuko, Department of Hematology, FMC, Umuahia, Nigeria, Email ogbollins2002@yahoo.com Received: April 18, 2018 | Published: August 17, 2018 Abstract Background: There is an increasing prevalence of Multiple Myeloma (MM) in Nigeria. Unfortunately, there is a poor awareness of this hematological disease among the healthcare providers and the targeted population in the country. The aim of this study is to highlight some of the challenges encountered in the management of MM in Nigeria. Methods: By systematic literature search of previous publications on the management of MM in Nigeria using Google search engine, PubMed, MEDLINE, and the African Journal Online (AJOL) database. Result: The awareness of MM is still very poor among healthcare providers. Case ascertainment is still a big issue due to diagnostic dilemma surrounding the disease. Most cases are seen by orthopedic surgeons only to present to primary physician (Hematologist) after complication must have set in. When diagnosis is made the defnitive and supportive interventions are not readily available. The Hallmark is usually poor prognosis with a low survival interval (≤5% survive beyond 5 years post diagnosis). Conclusion: Late diagnosis coupled with poor health determinants such as low SES, poor access to good health care, and lack of health-promoting policies that covers MM patients are major contributors of poor health outcome of people living with MM in Nigeria. There is a need to embark on a public health awareness campaign on MM in Nigeria. It is recommended that the government should make early detection, and healthcare coverage of people living with MM and other cancers topmost priority. Keywords: multiple myeloma, management, challenges, nigeria, AJOL Hematology & Transfusion International Journal Research Article Open Access