Abstract
BACKGROUND: Multiple myeloma (MM) is primarily a disease of the elderly; data on young patients are limited. AIM: To evaluate the clinical characteristics and outcomes of MM patients aged ≤ 40 years. METHODS: We retrospectively analyzed newly diagnosed MM patients aged ≤ 40 years between 2013 and 2021. RESULTS: Of 1980 patients screened, 110 (5.5%) were ≤ 40 years (median age 36). Hypercalcemia, renal dysfunction, anemia, and bone lesions (CRAB) were seen in 11.9%, 17.3%, 42.7%, and 92.6% of patients, respectively. More than one-third had International Staging System (ISS) Stage III, 20.8% had HR cytogenetics and 21.6% had light chain disease (LCD). Macrofocal multiple myeloma (MFMM) seen in 31% of patients. Bortezomib-cyclophosphamide-dexamethasone (VCd) and bortezomib-lenalidomide-dexamethasone (VRd) were the common induction regimens. 26.8% received autologous stem cell transplantation (ASCT). At a median follow-up of 44.2 months, the median progression free survival (mPFS) was 45.9 months. 1-, 3-, and 5-year PFS rates were 84.9%, 62.2%, and 38.6% respectively. A 3-year PFS was 83.9% with proteasome inhibitor (PI) and 78.7% with immunomodulatory drug (IMiD) as maintenance therapy. A 5-year PFS was superior with ASCT (58.5%) versus without (27.8%). Poor PFS was associated with anemia, renal dysfunction, poor performance status, high risk cytogenetics, VCd (vs. VRd), poor response to induction chemotherapy, no maintenance therapy and no ASCT. CONCLUSION: Young MM patients had encouraging survival outcomes despite resource limitations and limited access to novel agents. TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.