Abstract Introduction: Although multiple myeloma (MM) represents only 1% of the global burden of cancer, its prevalence increases as the population ages. Monitoring our progress to treat MM requires novel tools for epidemiologic surveillance. Methods: We developed a surrogate measure for the burden of MM in Mexico during 2015, representing the number of prevalent and incident cases of MM at every public and private Mexican health institution. We identified individuals through the ICD-10 codes C90.0-C90.3. Hospitalizations and mortality due to MM were also studied. The number of cases was standardized to represent the age-specific Mexican population obtained through census data. We conducted structured interviews to clinicians to gather data on treatment and clinical characteristics Results: In 2015, 2569 patients with MM were attended, 2039 unique patients were hospitalized, and 1169 patients died in the Mexican health system. The incidence rate for MM was 1.16 × 100,000 inhabitants-year during the study period. Therapies were consistent between the public and private sectors. Incidence was higher among elder men. Conclusion: Our findings align with epidemiologic trends in the developing world. As we face aging of the population and new therapies extend the survival of patients with MM, our surrogate will be useful for epidemiologic surveillance.

Resumen Introducción: Aunque el mieloma múltiple (MM) representa el 1% de la carga del cáncer, su prevalencia aumenta conforme la población envejece. Se requieren herramientas novedosas de vigilancia epidemiológica para monitorizar nuestros avances en su tratamiento. Métodos: Desarrollamos una medida sustituta para la carga de MM en 2015, representando la prevalencia e incidencia del MM en México. Identificamos los casos mediante los códigos CIE-10 C90.0-C90.3. Estudiamos las hospitalizaciones y la mortalidad por MM. Se estandarizó el número de casos para representar a la población por grupos de edad, conforme a datos obtenidos de censos. Realizamos entrevistas a especialistas para obtener datos sobre el tratamiento y las características clínicas. Resultados: En 2015 en México se atendieron 2,569 pacientes con MM, se hospitalizaron 2,039, y fallecieron 1,169. La tasa de incidencia para MM fue de 1.16 x 100,000 habitantes en este año, siendo mayor en hombres de la tercera edad. El tratamiento fue similar en los sectores público y privado. Conclusión: Nuestros hallazgos coinciden con las tendencias epidemiológicas de países en desarrollo. Nuestra medida servirá para la vigilancia epidemiológica ante la realidad de una población de edad cada vez mayor y el uso de terapias que prolongan la supervivencia de los pacientes con MM.

There is no clear understanding of the outcome of reinfection in New World cutaneous leishmaniasis, and its role in the relationship to the development of protection or secondary disease. For this reason, reinfection experiments with homologous (Leishmania panamensis-L. panamensis) and heterologous (L. major-L. panamensis) species of leishmaniae were conducted in the hamster model. The different protocols for primary infections prior to the challenge with L. panamensis were as follows: (a) L. major, single promastigote injection, (b) L. major, three booster infections, (c) L. panamensis, followed by antimonial treatment to achieve subclinical infection, (d) L. panamensis, with active lesions, (e) sham infected, naive controls. Although all reinfected hamsters developed lesions upon challenge, animals with active primary lesions due to L. panamensis, and receiving booster infections of L. major had the most benign secondary lesions (58-91% and 69-76% smaller than controls, respectively, P<0.05). Subclinically infected animals had intermediate lesions (40-64% smaller than controls, P<0.05), while hamsters which received a single dose of L. major had no significant improvement over controls. Our results suggested that L. major could elicit a cross protective response to L. panamensis, and that the presence and number of amastigotes persisting after a primary infection may influence the clinical outcome of reinfections.