# Presentation, treatment and clinical outcomes in young multiple myeloma patients treated at a tertiary care centre in a low middle-income country

## TL;DR

This study examines how multiple myeloma affects younger patients in a low-middle-income country, finding differences in symptoms, treatment responses, and survival rates compared to older patients.

## Contribution

The study provides insights into the unique clinical and treatment patterns of younger multiple myeloma patients in a low-middle-income setting.

## Key findings

- Younger patients showed higher rates of renal impairment and lactate dehydrogenase levels.
- Progression-free survival varied significantly across age groups, with the 41–50 years group having the longest survival.
- Treatment response rates and overall survival were lower in the youngest age group compared to older patients.

## Abstract

Multiple myeloma (MM), a plasma cell malignancy, predominantly affects individuals aged 65–74 years. However, its occurrence in younger populations (<55 years) is rare, posing unique challenges. This study explores the clinical presentation, outcomes and treatment regimens for MM patients aged 30–55, aiming to unravel age-specific patterns.

A retrospective chart review was conducted at Aga University Hospital, Karachi, focusing on MM patients aged 30–55 years. Data included patient demographics, clinical features, treatment modalities and outcomes. Statistical analysis employed STATA version 16.0, incorporating survival estimates, log-rank tests and Cox proportional survival regression models.

This study encompassed 68 confirmed MM patients, categorised by age groups: 30–40 years (13.23%), 41–50 years (44.11%) and 51–55 years (42.64%). Predominantly male (1.3:1 ratio), bone pains were prevalent among all groups, with 51–55 years exhibiting the highest pathological fracture rate. 30–40 years group showed higher renal impairment rates and lactate dehydrogenase levels. Velcade, thalidomide and dexamethasone were commonly used first-line regimens in the entire cohort in 41.17% of patients, closely followed by cyclophosphamide, bortezomib and dexamethasone in 29.41%. Partial response was predominant in the 30–40 years group, while other age groups showed varied responses. The younger patients demonstrated lower deep treatment response rates than their older counterparts. Progression-free survival was 37, 52 and 45 months orderly in each group, with a p-value of <0.001. The median overall survival (OS) for the entire group was 50.6 months (4.2 years), with OS rates of 77.8% (CI: 95%), 90.0% (CI: 95%) and 86.2% (CI: 95%), respectively, with a p-value of <0.001. Median OS in months was 45, 55.5 and 52, with a p-value of 0.08.

This single-center study sheds light on younger MM patients' unique challenges and treatment patterns. Despite the rarity of this age group's affliction, the findings underscore significant differences in clinical presentations, treatment responses and outcomes compared to the typical elderly MM population. The study highlights the importance of tailored approaches in managing MM across different age brackets, emphasising the need for further research to optimise therapeutic strategies and improve prognosis in this distinct patient cohort.