Need for More Research on Young Patients With Multiple Myeloma

Researchers highlighted the need for contemporary large-scale retrospective studies on young patients with multiple myeloma to improve knowledge on the disease’s presentation and outcomes in these individuals.

The review was published in Current Oncology.

Around 10% of multiple myeloma cases occur in individuals younger than age 50, the authors explained. However, these patients tend to be underrepresented in literature on the condition.

“The average years of life lost per patient is as high as 36 years for patients under 40 years and reaches up to 27 years for patients between the ages of 40 to 49 years. In contrast, the entire myeloma population loses 16.8 years of life on average to the disease,” the authors wrote.

Young patients with multiple myeloma are also burdened with the disease in their most productive professional years of life. However, previous research shows these individuals tend to tolerate treatment better than their older counterparts and have less discontinuation of therapy or dose reductions.

In the current review, experts sought to report on recent studies that assessed this cohort and focused on outcomes, treatments, and diagnosis characteristics.

They searched PubMed for relevant research published between January 2010 and December 2022. Sixteen retrospective studies were included in the review.

Any individual aged 50 or younger was considered a “young patient” for the purposes of the review.

Results showed these individuals tended “to have less advanced disease, more frequent light chain subtypes, and survive longer compared to their older counterparts,” the authors wrote. In addition, studies including young patients revealed an incidence of light chain disease ranging from 19% to 45%. In the general multiple myeloma population, this incidence is around 15%.

The authors highlighted that the available studies included a limited number of patients. These investigations also did not use the latest revised international staging system to classify patients. What’s more, “cytogenetics varied from one cohort to another, and most patients did not receive contemporary triplet/quadruplet treatments,” the researchers added.

Based on the included studies, they were unable to determine whether young patients with multiple myeloma have a higher family history of the disease.

Induction treatments that combined a proteasome inhibitor and an immunomodulatory drug were used by 15% to 69% of young patients.

In addition, the mix of thresholds used to characterize the disease in young patients, like creatinine, albumin, and calcium level, poses a challenge when it comes to comparing cohorts, researchers explained. It’s also difficult to determine whether younger patients with myeloma are more likely to present with high-risk cytogenetics. This is due in part to the limited number of patients included in studies, along with different techniques utilized in different cohorts.

“Further modern, large-scale studies are necessary to understand the genetic landscape of young patients with [multiple myeloma]. More advanced techniques such as next-generation sequencing should also aid in our understanding,” the authors said.

The review revealed a lack of information on the impact of current standard treatments in young patients.

Going forward, clinical trials should enroll young patients and the stratification of specific age groups should be improved upon, the authors wrote.

“Survivorship of young patients with [multiple myeloma] deserves particular attention given their long disease journey with multiple potential complications, including secondary malignancies. Further studies will elucidate if innovative cellular therapies such as upfront CAR T cells or other novel cellular therapies could be beneficial in this population,” the researchers concluded.

Reference

Tanguay M, Dagenais C, Le Blanc R, Ahmad I, Claveau JS, Roy J. Young myeloma patients: a systematic review of manifestations and outcomes. Curr Oncol. Published online May 23, 2023. doi:10.3390/curroncol30060396