# Epidemiology of Monoclonal Gammopathies in Sub‐Saharan Africa: A Systematic Review and Meta‐Analysis of MGUS and Multiple Myeloma

## TL;DR

This study reviews the prevalence and outcomes of monoclonal gammopathies in Sub-Saharan Africa, revealing higher rates and poorer survival compared to global averages.

## Contribution

The study provides the first systematic review and meta-analysis of MGUS and multiple myeloma epidemiology in Sub-Saharan Africa.

## Key findings

- The pooled prevalence of MGUS in Sub-Saharan Africa is 3.1%, and MM prevalence is 7.8%.
- MM patients in Sub-Saharan Africa have a mean survival of 34.7 months, with HIV-positive patients surviving only 9.9 months.
- Renal failure affects 30.1% of MM patients at diagnosis in the region.

## Abstract

Monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) are reported to occur more frequently in Black populations, particularly African Americans. However, despite Sub‐Saharan Africa (SSA) being home to the largest Black population globally, epidemiological data on MGUS and MM in the region remain scarce.

We conducted a systematic review and meta‐analysis of published studies from SSA to estimate the pooled prevalence of MGUS and MM, regional variations, survival outcomes and key clinical complications, including HIV‐associated MM, renal failure, anaemia and hypercalcaemia.

Forty‐five studies were included in this systematic review and meta‐analysis, with eight on MGUS and 37 on MM. The pooled prevalence of MGUS in SSA was 3.1% (95% CI: 0.8%–12.0%), while MM prevalence was 7.8% (95% CI: 5.6%–10.4%). MM burden was highest in Central Africa and lowest in West Africa, whereas MGUS prevalence peaked in Southern Africa. The pooled mean survival for MM was 34.7 months; 1‐year and 5‐year overall survival rates were 46.0% and 20.7%, respectively. HIV significantly modified MM outcomes: the pooled prevalence of MM among people living with HIV was 7.2% (95% CI: 1.9%–24.2%), and mean survival was markedly shorter in HIV‐positive patients (9.9 months) compared with HIV‐negative patients (36.7 months). Renal failure was highly prevalent, affecting 30.1% (95% CI: 23.5%–37.6%) of MM patients at diagnosis.

MM and MGUS impose a substantial and under‐recognised burden in SSA, with poorer survival outcomes compared with global averages. The high rates of delayed presentation, limited diagnostic capacity, absence of routine plasma cell disorder screening and restricted access to modern therapies likely contribute to the disparities observed. Strengthening diagnostic infrastructure and improving early detection and treatment pathways are urgently needed to advance equity in myeloma care across SSA.