Clinical profiles and outcomes of young versus elderly patients with multiple myeloma: A retrospective observational study from a tertiary cancer center in South India

ABSTRACT Export Background: In the West, the median age at diagnosis of multiple myeloma is 66 years, with only 2% of patients diagnosed below the age of 40 years. The median age at diagnosis of multiple myeloma in India is approximately a decade earlier. The clinical profiles and outcomes in young patients with multiple myeloma compared to older patients vary in different studies. Objectives: We aimed to study the clinical profiles and outcomes of young (≤50 years) patients compared to those of elderly patients with multiple myeloma, at our center. Materials and Methods: This was a retrospective observational study conducted from January 2012 to December 2019 in the Department of Medical Oncology at Vydehi Institute of Medical Sciences, Bangalore, a tertiary cancer center in South India. We included patients with newly diagnosed multiple myeloma and evaluated the patient characteristics, clinical and laboratory findings, response to treatment, and survival outcomes. Results: We enrolled 106 patients; the median age was 57 years (range, 32–74). There were 29 patients (27.4%) who were aged 50 years or below, and 5 (4.7%) were 40 years or younger. The male-to-female ratio was 1.9:1 for the overall population, but 0.6:1 in the cohort of young patients; P, 0.003. Most patients presented with International Staging System (ISS) Stage III disease, 80% (n = 20) and 90% (n = 53) in the young and elderly groups, respectively. In terms of clinical presentation in the young versus elderly cohorts, renal failure was less (5 [17.2%] vs. 19 [35.8%], respectively; P, 0.038), while anemia (22 [75.9%] versus 38 [76%], respectively; P, 0.496) and hypercalcemia (7 [24.1%] versus 9 [23%], respectively; P, 0.458) occurred to a similar extent. In the overall population, the chemotherapy regimen, bortezomib + thalidomide + dexamethasone (VTd), led to a better complete response rate compared to thalidomide + dexamethasone (Td) (15 [57.7%] versus 3 [37.5%], respectively; P, 0.022. The median survivals in the young versus elderly groups were 7.76 (95% CI, 6.24-9.06) vs 6.53 (95% CI, 5.38-7.80) years, respectively; P, 0.045. Conclusion: There are definite differences in clinical characteristics and survival outcomes of younger compared to older patients with newly diagnosed multiple myeloma. The results of our study will inform the design of larger prospective studies and help tailor the management strategies in each cohort of patients.