Epidemiology and approaches for management of relapsed and refractory multiple myeloma in Gulf Countries: a narrative review and insights from the Gulf multiple myeloma experts

Multiple myeloma (MM) is a hematologic malignancy characterized by the clonal proliferation of plasma cells, resulting in considerable morbidity and mortality. Although therapeutic advancements have improved clinical outcomes, this has been restricted to some high-income nations. Countries in the Gulf region, despite significant rises in gross domestic product (GDP), have resource-constrained environments and hence face unique challenges when it comes to the management of MM mainly because of the limited spending on healthcare (as a percentage of the GDP) in these countries. This narrative analysis explores the epidemiology, patient demographics, and therapeutic landscape of relapsed and refractory multiple myeloma (RRMM) in Gulf nations, including the United Arab Emirates (UAE), Qatar, Bahrain, Kuwait, and Oman. Our findings emphasize the growing incidence of MM in the region, with increased mortality rates owing to delayed diagnosis, restricted access to some of the advanced medicines in few areas, and disparities in care. Patients in the Gulf countries usually present at a younger age than their global counterparts, with median ages of diagnosis ranging from 43 to 58 years. Access to innovative treatments like CAR T-cell therapy and bispecific antibodies has been limited by high costs and infrastructural barriers. Stem-cell transplantation, although available in most countries, is insufficiently utilized, and treatment approaches frequently depend on conventional medicines. Obstacles to prompt diagnosis, difficulty in accessing treatment centers, limited availability of innovative treatment, and inadequate regional monitoring protocols, impede efficient illness management. Insights from the Gulf MM Advisory Board highlight the need for individualized treatment protocols, enhanced accessibility to novel treatments, and improvements in healthcare infrastructure. Cooperative initiatives among healthcare professionals, decision makers, and industry stakeholders are crucial for formulating regional treatment protocols and enhancing clinical trial networks. Reflecting on these shortcomings will be critical to improving patient outcomes and aligning MM care in the Gulf region with international standards.