# Optimising multiple myeloma therapy in resource-limited settings: current perspectives and challenges

## TL;DR

This paper reviews the challenges of treating multiple myeloma in low-resource areas and suggests strategies to improve care and reduce global health disparities.

## Contribution

The paper proposes a multifaceted strategy to optimize MM therapy in resource-limited settings through policy and healthcare system improvements.

## Key findings

- High-income countries use advanced therapies for multiple myeloma, while low-income countries rely on less effective treatments.
- Key challenges in resource-limited settings include late diagnosis, poor infrastructure, and lack of trained personnel.
- Proposed solutions include enhancing diagnostics, adapting treatment guidelines, and strengthening healthcare systems.

## Abstract

Multiple myeloma (MM) represents a significant global health challenge, with its incidence and mortality rates steadily increasing over recent decades. This review critically examines the current landscape of MM management, with a specific focus on resource-limited settings, where the disparities in diagnostic capabilities and treatment options are most pronounced. A comprehensive literature search was performed using multiple databases, encompassing peer-reviewed articles, clinical guidelines and conference abstracts from 2010 to 2024. Our analysis delineates the stark differences between therapeutic approaches in high-income versus low- and middle-income countries (LMICs). In high-income settings, the standard of care involves advanced induction regimens, autologous stem cell transplantation and maintenance therapy with novel agents, which collectively have contributed to improved patient outcomes. Conversely, LMICs often rely on more affordable yet less effective treatments, such as bortezomib- or thalidomide-based regimens, largely due to limited access to advanced diagnostics and high-cost therapies. Key challenges identified include late presentation, inadequate diagnostic infrastructure, economic constraints and a paucity of trained healthcare personnel. To address these issues, we propose a multifaceted strategy that emphasises the enhancement of diagnostic capacity, the adaptation of resource-stratified treatment guidelines and the strengthening of healthcare systems through targeted policy interventions and international collaborations. By bridging the gap between evidence-based MM care and the practical realities of under-resourced healthcare systems, this review aims to inform future clinical practice and policy, ultimately improving survival outcomes and reducing global health inequities in MM management.