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.
We analyzed the presenting features and survival in 1689 patients with multiple myeloma aged younger than 50 years compared with 8860 patients 50 years of age and older. Of the total 10 549 patients, 7765 received conventional therapy and 2784 received high-dose therapy. Young patients were more frequently male, had more favorable features such as low International Staging System (ISS) and Durie-Salmon stage as well as less frequently adverse prognostic factors including high C-reactive protein (CRP), low hemoglobin, increased serum creatinine, and poor performance status. Survival was significantly longer in young patients (median, 5.2 years vs 3.7 years; P < .001) both after conventional (median, 4.5 years vs 3.3 years; P < .001) or high-dose therapy (median, 7.5 years vs 5.7 years; P = .04). The 10-year survival rate was 19% after conventional therapy and 43% after high-dose therapy in young patients, and 8% and 29%, respectively, in older patients. Multivariate analysis revealed age as an independent risk factor during conventional therapy, but not after autologous transplantation. A total of 5 of the 10 independent risk factors identified for conventional therapy were also relevant for autologous transplantation. After adjusting for normal mortality, lower ISS stage and other favorable prognostic features seem to account for the significantly longer survival of young patients with multiple myeloma with age remaining a risk factor during conventional therapy.
Ludwig
Heinz
H
Department of Medicine, Wilhelminenspital, Montleartstr. 37, 1160 Vienna, Austria. heinz.ludwig@wienkav.at
Durie
Brian G M
BG
Bolejack
Vanessa
V
Turesson
Ingemar
I
Kyle
Robert A
RA
Blade
Joan
J
Fonseca
Rafael
R
Dimopoulos
Meletios
M
Shimizu
Kazuyuki
K
San Miguel
Jesus
J
Westin
Jan
J
Harousseau
Jean-Luc
JL
Beksac
Meral
M
Boccadoro
Mario
M
Palumbo
Antonio
A
Barlogie
Bart
B
Shustik
Chaim
C
Cavo
Michele
M
Greipp
Philip R
PR
Joshua
Douglas
D
Attal
Michel
M
Sonneveld
Pieter
P
Crowley
John
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis