Presenting Features and Prognosis in 72 Patients With Multiple Myeloma Who Were Younger Than 40 Years

Abstract

The purpose of this study was to analyse the presenting clinical and laboratory features and the outcome of 72 patients with multiple myeloma (MM) who were younger than 40 years. The records of all Mayo Clinic patients with MM younger than 40 years who were seen between 1 January 1956 and 31 December 1992 were reviewed. Survival was measured from the date when treatment was required to the date of last follow-up or death. The frequency of MM in patients younger than 40 and 30 years in 3278 Mayo Clinic patients was 2.2% and 0.3%, respectively. The main presenting clinical features were bone pain (66%), fatigue (26%), extramedullary plasmacytomas (19%) and bacterial infection (11%). Renal function impairment (creatinine level > or = 177 micromol/l) and hypercalcaemia (serum calcium value > or = 2.75 mmol/l) occurred in 29% and 30% of patients, respectively. Among the 57 patients evaluable for response the objective response rate was 54%. 14/35 patients treated with a single alkylating agent achieved an objective response, whereas 17/22 patients given combination chemotherapy had an objective response (P=0.013). However, this higher response rate did not result in a significantly longer survival. The median survival for the 72 patients was 54 months. Patients with good prognostic features (normal renal function or low beta 2-microglobulin level) had a median survival of 8 years. The actuarial survival at 5 and 10 years after initiation of therapy was 43% and 13%, respectively. In summary, survival in very young patients with myeloma is longer than that observed in series of patients of all ages, especially in those with good prognostic factors.

Liver Involvement in Multiple Myeloma: A Hospital Based Retrospective Study

“…However we could not get any cases below the age of 30 years. Our finding is similar to the study done by Blade et al (1996).Though the obvious jaundice was not reported in our study, serum level of bilirubin (all total, direct and indirect) was found to be significantly higher compared with control groups. Observation of symptomatic liver disease is very rare in multiple myeloma and occasional jaundice may be seen (Thomas et al, 1985) which is almost associated with the amyloid deposition in hepatic tissues (Yamamoto et al, 1995).…”

Early harvest and late transplantation as an effective therapeutic strategy in multiple myeloma

“…33 However, this same group is known to have an improved survival with standard melphalan chemotherapy. 34 One cannot overemphasize the importance of tumor biology in predicting the outcome of myeloma transplant studies. Virtually all published studies indicate that high ␤ 2 -microglobulin concentration, high labeling index, and low hemoglobin levels are adverse prognostic factors in highdose therapy and stem cell transplantation.…”

Paraproteinemia, plasmacytoma, myeloma and HIV infection

“…Similarly, the median age of HIV-negative patients with MGUS is 64 years, with only 4% younger than 40 years, and a 10 year period before the development of plasma cell neoplasm in the subpopulation that progresses; 12 Ishida and Dorfman 77 found fewer than 25 well-documented reports in the literature of multiple myeloma occurring before the age of 30 years. Two recent reports from Kyle's group have described patients with myeloma under the age of 40 (only 2% of myeloma patients) 78 and under the age of 30 (only 0.3% of myeloma patients). 79 In contrast to the general population, the mean patient age in the reported cases of MGUS, plasmacytoma and myeloma in AIDS patients is 33 years (34 years for MGUS, 32 years for documented neoplasms).…”