Diagnosing and treating young multiple myeloma patients. Experience from a tertiary-care center in Mexico

Abstract

Background: Multiple myeloma (MM) is an infrequent hematologic entity in patients 40 years or younger, with a clinical presentation and disease course that differs from the older group. We report the clinical outcomes after diagnosing and treating young MM individuals from a hematologic referral center in a limited-resource context and briefly report the pertinent literature. Materials and methods: MM patients ≤ 40 years diagnosed and treated at a public hospital between 2008 and 2021were included, and their clinical features at diagnosis and during follow-up were recorded. Salient features, progression- free survival (PFS) and overall survival (OS) were compared with those of the older cohort. Results: We identified 8 (4.9%) MM patients ≤ 40 years at diagnosis. The most frequent initial clinical presentation was lower back pain and neurologic manifestations in the lower limbs; all presented with bony lesions. The extramedullary disease was identified in half; two patients met all CRAB criteria. There were no differences between young and older patients in median PFS (66 vs. 29.5 months, p = 0.331) and OS (77.8 vs. 55.1 months, p = 0.361). Median OS was similar among young and old patients who underwent autologous stem cell transplantation (77.8 vs. 79.1, p = 0.730). Conclusion: MM is rare in young patients; it predominates in males and has a torpid clinical course with high mortality. Early transplantation offers a reasonable opportunity for longer survival.

Keywords

• Multiple myeloma. Young adult. Autologous hematopoietic cell transplantation.