Myeloma in India: CureTalk In Conversation With Dr. Lalit Kumar, Professor of Medical Oncology, All India Institute of Medical Sciences (AIIMS), Delhi, India

Dr. Lalit Kumar, AIIMS, INDIA

Dr. Lalit Kumar, MD ; DM ; FAMS ; FASc.
Professor of Medical Oncology

 

Dr. Lalit Kumar is Professor of Medical Oncology at one of the premier medical institutions in India, All India Institute of Medical Sciences (AIIMS), Delhi, India.  AIIMS is considered as one of the most prestigious medical colleges of India and is globally recognized for providing quality and low-cost medical care to patients.

I caught up with Dr. Lalit Kumar to understand myeloma treatment scenario in India. Dr. Kumar was ever helpful and taking time out of his busy schedule was gracious enough to answer my queries over email. Click here to view Dr. Kumar’s publications.

Below is our interview:

Q) What would be the average number of patients suffering from multiple myeloma in India?

Based on population based cancer registries , number of myeloma cases is given below.

Males Females Pooled
2010 9651 4890 4541
2015 12605 5329 17934
2020 15947 5807 21754

Ref:  Ramnath Takiar, Deenu Nadayil, A Nandakumar. Projections of Number of Cancer Cases in India (2010-2020) by Cancer Groups. Asian Pacific J Cancer Prev, 11, 1045-1049

 Q) Multiple myeloma, as we know is a rare condition, and hence which are the tests conducted for diagnosis in India?

At our centre, we are able to do standard work up as done in any advanced center. Situation may be almost similar in metro corporate hospitals by and large. Generally, most centers are able to do CBC, ESR, complete biochemistry, serum electrophoresis, bonemarrow, and x ray survey. Some centers may not have facilities for serum b2 microglobulin. Facilities for FISH are not available routinely in most centers. This test is outsourced to private labs mostly. 

Q) Is FISH analysis a standard part of baseline testing for those newly diagnosed with myeloma?

Not yet.

Q) What tests do you use to monitor a patient who is on maintenance therapy?

We generally monitor with serum or urine electrophoresis periodically, we are now doing serum free light chains also for the past 1 year. 

Q) What are the drugs available for treatment in India? Revlimid from Celgene.co is not available in India, so which is the drug used instead of this?

Generic brands of thalidomide, lenalidomide, and bortezomib are available, more than 5 companies make these drugs. 

Q) What are the treatments available at AIIMS for myeloma patients?

We are able to use all 3 drugs- thalidomide, lenalidomide, and bortezomib based combinations. 

Q) Are any myeloma clinical trials being conducted at AIIMS?

We have just completed a phase 3 trial comparing thalidomide/dexamethasone v/s lenalidomide and dexamethasone in newly diagnosed myeloma. 120 patients have been recruited. 

Another phase III randomized study currently ongoing is CTD (cyclophosphamide, thalidomide and dexamethasone) versus bortezomib and dexamethasone in patients with light chain induced renal failure; 43 patients have been recruited so far. 

Q)  Are clinical trials discussed as a treatment option with patient’s here/India?

Once there is ongoing trial, then you explain and offer patients to be enrolled. But such situation is not very common. 

Q)  How can myeloma patients enroll for participating in clinical trials?

There are no International trials to best of my knowledge; there are not any other clinical trials by Indian Pharma co. 

Q)  What are the survival statistics for myeloma patients treated at AIIMS?

For young patients (<65 Y) who have been treated with stem cell transplant, an estimated overall survival at 5 years was 62% and progression free survival was 41% at 5 yrs.  

Q) What would be the average cost of treatment for myeloma in India?

In a government hospital like AIIMS, (funding by central govt) the cost of transplant comes to less than 3 lacs rupees (approx. 6000 US $). Private hospital charges approx. 8 lacs (approx. 16000 US $). Thalidomide would cost 3000 INR per month; Lenalidomide is about 15000 INR per month and bortezomib 20,000 INR per month. Zoledronic acid (injections) costs about 1500 INR per month. 

So, for a person on Lenalidomide + dexa and Zoledronic acid cost would come about 20,000.00 INR (approx. 370 US $) per month. 

Q) Does AIIMS have stem cell harvesting/ transplant facilities ?

Yes. We have done more than 300 auto stem cell transplants so far, data on 170 patients have been reported recently. 

Kumar L, Cyriac SL, Tejomurtula TV, Bahl A, Biswas B, Sahoo RK, Mukherjee A, Sharma O. Autologous stem cell transplantation for multiple myeloma:  identification of prognostic factors. Clin Lymphoma Myeloma  Leuk. 2013Feb;13(1):32-41.. Epub 2012 Oct 22.

Kumar L, Ghosh J, Ganessan P, Gupta A, Hariprasad R, Kochupillai V. High-dose chemotherapy with autologous stem cell transplantation for multiple myeloma: what predicts the outcome? Experience from a developing country. Bone Marrow Transplant. 2009 Mar;43(6):481-9. Epub 2008 Nov 3

 Q) Where else in India can stem cells be harvested?

There are more than 10 centres in India doing regular stem cell transplants. These include- Tata Memorial Hospital, Mumbai, Tata Memorial Centre, Kolkata, CMC Vellore, then centres in Mumbai, Pune, Hyderabad, Chennai, Lucknow and Delhi etc.

Q) When is a stem cell transplant suggested as treatment option?

At our center we advise  transplant after 4 to 6 months of induction therapy as an elective procedure for patients who have shown good response (complete or very good partial response). 

Q) What type of SCT is common in India, allo or auto?

This is mainly autologous stem cell Tx, a few allo transplants have been done.

I thank Dr. Lalit Kumar for helping us to put up relevant myeloma information on treatments, drugs available, cost of treatment etc on CureTalk for our international myeloma community.

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