Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience

Alexis Caulier (1) , Murielle Roussel (2) , Pierre Morel (1, 3) , Naelle Lombion , Benoit Branco , Jean Galtier (4) , Cyrille Hulin (4) , Aurore Perrot (5) , Valentine Richez (6) , Anne-Victoire Michaud (7) , Cyrille Touzeau (8, 9, 10, 11) , Chantal Doyen , Clara Mariette (12) , Denis Caillot (13) , Stephanie Harel (14) , Pascal Lenain (15) , Sarah Ivanoff (16) , Jean Fontan (17) , Anne-Marie Stoppa (18) , Salomon Manier (19, 20) , Laurent Garderet (21) , Xavier Leleu (22) , Jean-Pierre Marolleau (1, 23) , Bertrand Arnulf (24) , Herve Avet-Loiseau (5) , Bruno Royer (1)

1 CHU Amiens-Picardie
2 CHU Limoges
3 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
4 CHU Bordeaux
5 IUCT Oncopole - UMR 1037 - Institut Universitaire du Cancer de Toulouse - Oncopole
6 Service hématologie Nice
7 Département de Médecine Nucléaire [CHU Nantes]
8 CRCINA-ÉQUIPE 10 - Regulation of Bcl2 and p53 Networks in Multiple Myeloma and Mantle Cell Lymphoma
9 Service d'Hématologie [Nantes]
10 SIRIC - Site de Recherche Intégrée sur le Cancer [Nantes]
11 SIRIC-ILIAD - Site de Recherche Intégrée sur le Cancer - Imaging and Longitudinal Investigations to Ameliorate Decision-making
12 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
13 CHU Dijon
14 Service d'Immunopathologie [Hôpital Saint-Louis, Paris]
15 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
16 Pathologie cellulaire : aspects moléculaires et viraux / Pathologie et Virologie Moléculaire
17 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
18 Service d’Hématologie [Institut Paoli Calmettes, Marseille]
19 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
20 CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277
21 CHU Saint-Antoine [AP-HP]
22 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
23 HEMATIM - HEMATIM - Hématopoïèse et immunologie - UR UPJV 4666
24 AP-HP - Hopital Saint-Louis [AP-HP]

Multiple myeloma (MM) is rare in young patients, especially before age 40 years at diagnosis, representing <2% of all patients with MM. Little is known about the disease characteristics and prognosis of these patients. In this study, we examined 214 patients diagnosed with MM at age <= 40 years over 15 years, in the era of modern treatments. Among them, 189 patients had symptomatic MM. Disease characteristics were similar to older patients: 35% had anemia, 17% had renal impairment, and 13% had hypercalcemia. The staging was ISS-1 in 52.4%, ISS-2 in 27.5%, and ISS-3 in 20.1%. Overall, 18% of patients had high-risk cytogenetics [del 17p and/or t(4;14)]. Ninety percent of patients received intensive chemotherapy followed by autologous stem cell transplant, and 25% of patients had allogeneic stem cell transplant predominantly at time of relapse. The median follow-up was 76 months, the estimated median overall survival was 14.5 years, and the median progression free-survival was 41 months. In multivariate analysis, bone lesions (hazard ratio [HR], 3.95; P =.01), high ISS score (HR, 2.14; P =.03), and high-risk cytogenetics (HR, 4.54; P <.0001) were significant risk factors for poor outcomes. Among predefined time-dependent covariables, onset of progression (HR, 13.2; P <.0001) significantly shortened overall survival. At 5 years, relative survival compared with same age- and sexmatched individuals was 83.5%, and estimated standardized mortality ratio was 69.9 (95% confidence interval, 52.7-91.1), confirming that MM dramatically shortens the survival of young patients despite an extended survival after diagnosis.

Domaines: Sciences du Vivant [q-bio]

Alexis Caulier, Murielle Roussel, Pierre Morel, Naelle Lombion, Benoit Branco, et al.. Epidemiological landscape of young patients with multiple myeloma diagnosed before 40 years of age: the French experience. Blood, 2021, 138 (25), pp.2686-2695. ⟨10.1182/blood.2021011285⟩. ⟨hal-03578209⟩