Multiple Myeloma in Young Adults-Insights From a Tertiary Care Cancer Centre in India

Multiple myeloma (MM) is primarily a disease of the elderly; data on young patients are limited.

To evaluate the clinical characteristics and outcomes of MM patients aged $\le$ 40 years.

We retrospectively analyzed newly diagnosed MM patients aged ≤ 40 years between 2013 and 2021.

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.

Young MM patients had encouraging survival outcomes despite resource limitations and limited access to novel agents.

The authors have confirmed clinical trial registration is not needed for this submission.