Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience.
(2021) Blood — Vol. 138, n° 25, p. 2686-2695 (2021)
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Roussel, Murielle 
Doyen, Chantal
- Abstract
- Multiple myeloma (MM) is rare in young patients, especially before age 40 years at diagnosis, representing <2% of all patients with MM. Little is known about the disease characteristics and prognosis of these patients. In this study, we examined 214 patients diagnosed with MM at age ≤40 years over 15 years, in the era of modern treatments. Among them, 189 patients had symptomatic MM. Disease characteristics were similar to older patients: 35% had anemia, 17% had renal impairment, and 13% had hypercalcemia. The staging was ISS-1 in 52.4%, ISS-2 in 27.5%, and ISS-3 in 20.1%. Overall, 18% of patients had high-risk cytogenetics [del 17p and/or t(4;14)]. Ninety percent of patients received intensive chemotherapy followed by autologous stem cell transplant, and 25% of patients had allogeneic stem cell transplant predominantly at time of relapse. The median follow-up was 76 months, the estimated median overall survival was 14.5 years, and the median progression free-survival was 41 months. In multivariate analysis, bone lesions (hazard ratio [HR], 3.95; P = .01), high ISS score (HR, 2.14; P = .03), and high-risk cytogenetics (HR, 4.54; P < .0001) were significant risk factors for poor outcomes. Among predefined time-dependent covariables, onset of progression (HR, 13.2; P < .0001) significantly shortened overall survival. At 5 years, relative survival compared with same age- and sex-matched individuals was 83.5%, and estimated standardized mortality ratio was 69.9 (95% confidence interval, 52.7-91.1), confirming that MM dramatically shortens the survival of young patients despite an extended survival after diagnosis.
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Citations
Caulier, A., Roussel, M., Morel, P., Lombion, N., Branco, B., Galtier, J., Hulin, C., Perrot, A., Richez, V., Michaud, A.-V., Touzeau, C., Doyen, C., Mariette, C., Caillot, D., Harel, S., Lenain, P., Ivanoff, S., Fontan, J., Stoppa, A.-M., et al. (2021). Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience. Blood, 138(25), 2686-2695. https://doi.org/10.1182/blood.2021011285 (Original work published 2021)