Myeloma in India: CureTalk in Conversation with Dr. Pankaj Malhotra, Additional Professor of Clinical Hematology, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India

Dr. Pankaj Malhotra

Dr. Pankaj Malhotra is Additional Professor of Clinical Hematology at Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India. PGIMER is one of the premier medical institutions in India. I had a chance to interview Dr. Pankaj Malhotra regarding the treatment scenario of multiple myeloma in India and discuss myeloma drugs that are available here. Dr. Malhotra was gracious to find time to answer my questions and I thank him for it.

Please find the interview below:

With new drug, POMALYST (pomalidomide) being approved by FDA, myeloma patients in the US have further hope. Do you think that POMALYST would reach India anytime soon?

It’s unlikely to be available in India in the near future.

It is an expensive drug priced at $10,500 per 28-day cycle. Which is the most expensive myeloma drug in India?

Generic lenalidomide is the most expensive here. 25mg of Lenalidomide 21 day cycle would cost approximately $400.

What kind of myeloma treatment is opted for at PGI? Does it follow the Mayo Clinic conservative approach or does it opt for a Total Therapy approach and hit myeloma hard at the beginning?

We follow the more conservative approach and try various drugs and combinations to keep myeloma in check.

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

All the standard tests like CBC, ESR, complete biochemistry, serum electrophoresis, bone marrow, and x ray survey are done. 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.

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

Routine serum protein electrophoresis (SPEP) and Free light chains are measured (FLC) to monitor a patient.

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?

Excepting Carfilzomib and Pomalidomide, all other drugs are available in India. Generic bortezomib costs approx $ 200/cycle.

What are the treatments available at PGIMER for myeloma patients?

We do all the standard treatments including auto stem cell transplants.

Are any myeloma clinical trials being conducted at PGI? Are clinical trials discussed as a treatment option with patients here/India?

No clinical trials are ongoing currently at PGI and they are rarely discussed with patients.

What are the survival statistics for myeloma patients treated at PGI?

The statistics varies depending upon affordability and literacy level. Out of 36 patients who had undergone auto SCT since 2003 at our center (Affordable and mostly literate), the mortality rate is 5.4% and overall survival 85%.

Does PGI have stem cell harvesting transplant facilities? Where else in India can stem cells be harvested?

Yes, PGI has stem cell harvesting facilities, and there are over 30 centers in India where stem cell can be harvested.

When is a stem cell transplant suggested as treatment option?

Patients with myeloma who are <70 years, fit and can afford the costs go for transplants.

What types of SCT are commonly prescribed in India, allo or auto?

99% of SCTs  done in India for myeloma are auto transplants.

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

Cost of drugs, auto stem cell transplant in a government aided hospital like PGI or AIIMS would cost anything up to $4000, however, the same treatment in a private sector can cost anywhere up to $20,000.

I thank Dr. Pankaj Malhotra for helping us to put up relevant myeloma information on treatments, drugs available, cost of treatment etc in India for our international myeloma community.

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