General MM

A retrospective study of early-onset multiple myeloma

Multiple myeloma (MM) is usually found in patients (pts) over the age of 65. A very small number of pts is detected before the age of 40 (~2%) or under the age of 30 (~0.3%). Because of the low incidence of early-onset MM there is limited data regarding the clinicopathology and prognosis of the disease in the young population. 

Artur Jurczyszyn from the Department of Hematology, Jagiellonian University Medical College, Cracow, Poland, and colleagues in a study in the journal Leukemia and Lymphoma present data of a retrospective study of a cohort of young MM patients ≤ 30 years of age. The analysis included 52 pts; 47 diagnosed after 2006 and 5 diagnosed between 1989−2006. This is the first study in the era of novel agents that focuses exclusively on MM pts up to the age of 30.

Key Data:
  • Median age = 28 (8−30)
  • Male to female ratio = 2.1/1 (35:17)
  • International Staging System (ISS) I = 68% (32/47) (pts diagnosed after 2006)
  • Durie−Salmon stage I = 1; IIIA = 2; IIIB = 2 (pts diagnosed between1989−2006)
  • IgG isotype = 55% (27/49)
  • Non-IgG isotype = 45% (22/49)
  • Light-chain only disease = 22% (11/49)
  • Elevated serum lactate dehydrogenase (LDH) = 48% (19/40)
  • Most common cytogenetic abnormality = del(13q) in 31% pts (8/26)
  • Lytic lesions = 82% pts (36/44)
  • Hypercalcemia (Calcium ≥65 mmol/L) = 14% pts (6/42)
  • Renal failure (eGFR ≤ 60 ml/min) = 18% pts (4/22)
  • Response rates and survivals were analyzed for a subset of 37 pts diagnosed after 2006; these pts received front-line monotherapy or combined treatment with novel agents and/or were subjected to ASCT
  • Pts treated with novel agents = 85% (29/34)
  • Pts treated with front-line autologous stem cell transplant (ASCT) = 62% (21/34)
  • Overall response rate (ORR) to front-line treatment = 71%
  • ORR to induction treatment plus ASCT = 90%
  • Median follow-up period = 86 months (95% CI: 45−121)
  • Median overall survival (OS) = 166 months (95% CI: 53−222)
  • 5-year OS = 77% (95% CI: 61.0−9)

This study reveals that 30-year-old or younger MM pts show similar and possibly better responses to treatment than those of older pts. However, none of the parameters analyzed revealed a correlation with OS rates, underlying that at the moment there are no prognostic markers for younger MM pts.

References

Jurczyszyn A. et al. Multiple myeloma in patients up to 30 years of age: a multicenter retrospective study of 52 cases. Leukemia & Lymphoma. 2018 Jul 22; 22:1−6. DOI: 10.1080/10428194.2018.1480766.

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