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

Abstract

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.

Figure 1

Cumulative relative survival in the entire sample of 10 549 patients stratified by age (A), age and sex (B), age and ISS stage (C), and age and performance status (D) in all patients, in patients treated with conventional therapy stratified by age and stage (Ci) and age and performance status (Di), and in patients treated by high-dose therapy stratified by age and stage (Cii) and age and performance status (Dii). Inserts show median values adjusted for relative survival and P values.

Figure 2

Cumulative relative survival in patients treated with conventional therapy (A) and high-dose therapy (B) in patients younger than 50 years or 50 years and older and in patients younger than 40 years or 40 years and older (C,D). Inserts show median values adjusted for relative survival and P values.

Figure 3

Cumulative relative survival in patients treated during different times of enrollment. (A) Relative survival of conventionally treated patients was significantly longer in those enrolled between 1999 and 2002 compared with patients enrolled earlier (P < .001). (B) Relative survival in patients treated with high-dose therapy was similar during the different time periods of enrollment. Inserts show median values adjusted for relative survival and P values.