Hemato-Oncology
Contributions
Type: Publication Only
Background
Multiple myeloma is uncommon in persons younger than the age of 50. Conflicting reports have been published concerning the presenting features in this age group. The question regarding characteristics in presentation is clinically relevant since significant differences in biological features have been demonstrated in several malignancies.
Aims
We analyzed the presenting features of patients with multiple myeloma aged younger than 50 years currently treated in our center.
Methods
Patients fullfilling diagnostic criteria for multiple myeloma currently treated in our center and younger than the age of 50 were included for analysis. The following information was available: age, sex, date of birth, date of diagnosis, type, percentage of BM inflitration, FISH, serum levels of immunoglobulins free light chains, hemoglobin, creatinine, albumin,and b2 microglobulin,ISS stage, bone lytic lesions, proteinuria, and plasmocytoma
Results
Of the total of 23 patients studied, median age was 42 years (37.5-47), with 36.3% younger than 40. In accordance with previously published studies1, the patients were more frequently male (81.8%), had favorable features such as low International Staging System (ISS) (78.6% ISS I-II) as well as relatively small frequency of adverse prognostic factors including hemoglobin <10gr/dL (33.3%), serum creatinine>2mg/dL (16.6%), albumin < 3.5m/dL (44.4%), b2 microglobulin > 3.5mg/dL (42.8%), and calcium > 10mg/dL in only 27.7% of cases. However, most of the cases (71.42%) showed bone marrow plasma cell infiltration > 30% and bone lytic lesions were present in 88.2% of cases. As usually described, the most common isotype was IgG (47.6%) while that of light chain myeloma was higher than frequently reported (40.9%). FISH analysis was available in 22 patients. Surprisingly, t (11; 14) was present in 13 cases (59.1%). This is significantly higher than the normally reported frequency of this translocation (15 to 20%) in myeloma patients2-3 (binomial test with p <0.001, equal than 0.02, respectively). Patients carrying such abnormality were younger (mean age of 40 year vs. 46 year), had lower b2 microglobulin values (mean 3.1mg/dL vs 5.2mg/dL), lower serum FLC kappa (38.6 vs 150mg/dL), lambda (8.3 vs 47mg/dL), and FLC ratio (4.82 vs 24.75 mg/dl). Moreover, the group revealed more plasma cell infiltration (75% vs. 47.5%), higher proteinuria (2.9gr/day vs 0.19gr/day), and only 20% of these patients suffered from plasmocytomas. Patients younger than 40 did not show differences in any of parameters evaluated.
Summary
In summary, our cohort of young myeloma patients from a single center showed at presentation a less aggressive disease (low ISS stage, and low frequency of b2 microglobulin higher than 3.5mg/dL, hypercalcemia, anemia and renal failure), as previously suggested1. Interestingly, we found a higher frequency of t(11;14) by FISH analysis in this age group. The data may support the fact that t (11;14) is present at the earliest stage of plasma cell dyscrasias4.
Further studies are needed to evaluate the different biological nature of Multiple Myeloma in this age group.
References
1Ludwig H et al. Blood.2008; 111: 4039-4047
2Konigsberg R et al. J Clin Oncol. 2000; 18: 804-812
3Fonseca R et al. Blood. 2002; 99: 3735-3741
4Avet-Loiseau H et al. Cancer Res. 1999; 59:4546-4550
Keyword(s): Myeloma, Young adult
Session topic: Publication Only
Type: Publication Only
Background
Multiple myeloma is uncommon in persons younger than the age of 50. Conflicting reports have been published concerning the presenting features in this age group. The question regarding characteristics in presentation is clinically relevant since significant differences in biological features have been demonstrated in several malignancies.
Aims
We analyzed the presenting features of patients with multiple myeloma aged younger than 50 years currently treated in our center.
Methods
Patients fullfilling diagnostic criteria for multiple myeloma currently treated in our center and younger than the age of 50 were included for analysis. The following information was available: age, sex, date of birth, date of diagnosis, type, percentage of BM inflitration, FISH, serum levels of immunoglobulins free light chains, hemoglobin, creatinine, albumin,and b2 microglobulin,ISS stage, bone lytic lesions, proteinuria, and plasmocytoma
Results
Of the total of 23 patients studied, median age was 42 years (37.5-47), with 36.3% younger than 40. In accordance with previously published studies1, the patients were more frequently male (81.8%), had favorable features such as low International Staging System (ISS) (78.6% ISS I-II) as well as relatively small frequency of adverse prognostic factors including hemoglobin <10gr/dL (33.3%), serum creatinine>2mg/dL (16.6%), albumin < 3.5m/dL (44.4%), b2 microglobulin > 3.5mg/dL (42.8%), and calcium > 10mg/dL in only 27.7% of cases. However, most of the cases (71.42%) showed bone marrow plasma cell infiltration > 30% and bone lytic lesions were present in 88.2% of cases. As usually described, the most common isotype was IgG (47.6%) while that of light chain myeloma was higher than frequently reported (40.9%). FISH analysis was available in 22 patients. Surprisingly, t (11; 14) was present in 13 cases (59.1%). This is significantly higher than the normally reported frequency of this translocation (15 to 20%) in myeloma patients2-3 (binomial test with p <0.001, equal than 0.02, respectively). Patients carrying such abnormality were younger (mean age of 40 year vs. 46 year), had lower b2 microglobulin values (mean 3.1mg/dL vs 5.2mg/dL), lower serum FLC kappa (38.6 vs 150mg/dL), lambda (8.3 vs 47mg/dL), and FLC ratio (4.82 vs 24.75 mg/dl). Moreover, the group revealed more plasma cell infiltration (75% vs. 47.5%), higher proteinuria (2.9gr/day vs 0.19gr/day), and only 20% of these patients suffered from plasmocytomas. Patients younger than 40 did not show differences in any of parameters evaluated.
Summary
In summary, our cohort of young myeloma patients from a single center showed at presentation a less aggressive disease (low ISS stage, and low frequency of b2 microglobulin higher than 3.5mg/dL, hypercalcemia, anemia and renal failure), as previously suggested1. Interestingly, we found a higher frequency of t(11;14) by FISH analysis in this age group. The data may support the fact that t (11;14) is present at the earliest stage of plasma cell dyscrasias4.
Further studies are needed to evaluate the different biological nature of Multiple Myeloma in this age group.
References
1Ludwig H et al. Blood.2008; 111: 4039-4047
2Konigsberg R et al. J Clin Oncol. 2000; 18: 804-812
3Fonseca R et al. Blood. 2002; 99: 3735-3741
4Avet-Loiseau H et al. Cancer Res. 1999; 59:4546-4550
Keyword(s): Myeloma, Young adult
Session topic: Publication Only