Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience

Author:

Caulier Alexis1,Roussel Murielle2ORCID,Morel Pierre13,Lombion Naelle4,Branco Benoît5ORCID,Galtier Jean6ORCID,Hulin Cyrille6,Perrot Aurore5ORCID,Richez Valentine7,Michaud Anne-Victoire8,Touzeau Cyrille8,Doyen Chantal9,Mariette Clara10,Caillot Denis11,Harel Stéphanie12,Lenain Pascal13,Ivanoff Sarah14,Fontan Jean15,Stoppa Anne-Marie16,Manier Salomon17,Garderet Laurent18,Leleu Xavier19,Marolleau Jean-Pierre1,Arnulf Bertrand12,Avet-Loiseau Hervé5,Royer Bruno12

Affiliation:

1. Hematology, CHU Amiens, Amiens, France;

2. Hematology, CHU Limoges, Limoges, France;

3. Univ. Lille, ULR 2694–METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France;

4. Hematology, Centre Hospitalier de Versailles, Le Chesnay, France;

5. Hematology, CHU Toulouse, Toulouse, France;

6. Hematology, CHU Bordeaux, Bordeaux, France;

7. Hematology, CHU Nice, Nice, France;

8. Hematology, CHU Nantes, Nantes, France;

9. Hematology, CHU Dinant-Godinne, Namur, Belgium;

10. Hematology, CHU Grenoble, Grenoble, France;

11. Hematology, CHU Dijon, Dijon, France;

12. Hematology, Hôpital Saint-Louis, Paris, France;

13. Hematology, CHU Rouen, Rouen, France;

14. Hematology, Hôpital Avicenne, Bobigny, France;

15. Hematology, CHU Besançon, Besançon, France;

16. Hematology, Institut Paoli-Calmettes, Marseille, France;

17. Hematology, CHRU Lille, Lille, France;

18. Hematology, Hôpital de la Pitié Salpêtrière, Paris, France; and

19. Hematology, CHU Poitiers, Poitiers, France

Abstract

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.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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