Multiple myeloma in younger patients: the role of age as prognostic factor

Abstract

The presenting features of 356 previously untreated multiple myeloma (MM) patients grouped according to age were analyzed in order (a) to elucidate the possible differences in initial clinical and laboratory features between patients younger than 50 years and the older ones and (b) to statistically assess the prognostic value of the parameters considered, with particular emphasis on the prognostic impact of age. Patients were divided into two groups: group I included 61 patients aged less than 50, group II comprised 295 patients aged 50 or more. No significant differences were found between the two groups in terms of either clinical or laboratory initial characteristics. The treatments adopted and the response to therapy did not differ in the two groups. The prognostic value of presenting features was evaluated for the whole cohort by univariate and multivariate analysis, considering both the observed survival rates and survival rates corrected for the effect of other independent causes of death, using a Poisson model. In both models, calcium level (RR 2.33), performance status (RR 1.83), and creatinine (RR 1.69) maintained their independent negative prognostic value. In contrast, the impact of age was different in the two models. In fact, patients younger than 50 seem to have a better prognosis when the observed survival rates are considered, but they show an increased risk of death when the model takes into account the expected mortality of the underlying population. In conclusion, this study shows that the younger cohort of MM patients has no distinctive initial characteristics with respect to older patients. In multivariate analysis, creatinine levels, calcemia, and performance status show a relevant negative independent prognostic value. Regarding the prognostic impact of age, survival seems to be better among patients younger than 50 than in older patients when the observed survival rates are considered but is significantly worse when the mortality of the corresponding general population, is taken into account.

Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group

“…Another relevant finding of this study is the low proportion of young patients observed in the entire group of patients studied, a phenomenon that had been addressed in some prior studies. 3,4,14 In our investigation, 16% of the patients were younger than 50 years, 3% were younger than 40 years, and 0.26% were younger than 30 years.…”

“…A previous study in 61 patients aged younger than 50 years showed no difference in presenting features compared with older patients. 3 Survival was significantly better compared with the older patient cohort but was significantly shorter in young patients after findings were corrected for differences in life expectancy. 3 Blade et al reported an increased frequency of renal impairment (30%) and hypercalcemia (29%) at presentation and median survival of 54 months in 72 patients younger than 40 years.…”

“…3 Survival was significantly better compared with the older patient cohort but was significantly shorter in young patients after findings were corrected for differences in life expectancy. 3 Blade et al reported an increased frequency of renal impairment (30%) and hypercalcemia (29%) at presentation and median survival of 54 months in 72 patients younger than 40 years. 4 The question regarding differences in presentation and in outcome in different age groups is clinically relevant since significant differences in prognostic and biologic features have been demonstrated in several other malignancies.…”

271 A Rare Case of Renal Recovery in a Young Patient with Multiple Myeloma

“…Younger patients present with more favorable features and have a better survival. Factors associated with improved survival include young males with low International Staging System (ISS) and Durie-Salmon stage, good performance status, and absence of poor prognostic features as high CRP, low hemoglobin, and severe renal insufficiency [11,12].…”

Le myélome multiple : la perspective des patients

“…La plupart d'entre eux ont plus de 50 ans, tandis que 10-15 % sont dans la quarantaine ou moins (Corso, 1998). Avec la chimiothérapie conventionnelle, la durée médiane de survie est de 3 ans.…”