The Clinical Analysis Of 61 Cases Of Newly Diagnosed Multiple Myeloma In Patients Aged 45 Years And Younger

Objective:To investigate the clinical characteristics,efficacy,and prognosis of newly diagnosed multiple myeloma(MM)patients aged 45 years and younger.Methods:To retrospectively analyze the clinical data of 61 patients aged 45 years and younger with a confirmed diagnosis of MM who were admitted to the Department of Hematology of the First Hospital of Jilin University from May2008 to August 2018,including clinical features,laboratory parameters,treatment responses and prognosis related factors.The young patients with MM were followed up until December 2018.The survival rates were calculated using the Kaplan–Meier method,and the survival data were compared using the log-rank test.A multivariate analysis was performed using the COX proportional hazards model.Results:1.MM patients aged 45 years and younger accounted for 9.6% of all cases during the same period and were more frequently male(54.1%),median age 43(27~45).2.77.0% patients presented with bone pain as the initial symptom.A majority had Ig G(39.3%),followed by Light chain(LC)MM(31.1%)and Ig D MM(14.8%).Patients with stage ? disease according to DS and ISS staging system accounted for 90.2% and 50.8%,respectively.36.1% patients had extramedullary disease,and lytic bone lesions were serious(75.4% of patients had three or more).Upon diagnosis,29.5% patients presented with renal insufficiency(e GFR ?60 m L/min),70.5% with hemoglobin concentrations ?10g/d L and 42.6% with thrombocytopenia.Patients with elevated lactate dehydrogenase(LDH)accounted for 27.9%;73.8% patients had the bone marrow plasmacytosis ratio over 30%,and a high proportion of patients had RB1 deletion,1q21 amplification and IGH rearrangement.3.Totally 43 patients received bortezomib-based front-line induction regimens with/without autologous hematopoietic stem cell transplantation(ASCT),and 18 patients received conventional therapy.The overall response rate(ORR)was 93.4% and deep response(?VGPR)rate was 68.9%.The response rates of patients who received bortezomib-based regimens were higher than that of patients with conventional therapy.The result of first-line ASCT was significantly superior to others,with complete response higher as85.7%.4.The median follow-up was 27.5(2~100.5)months.By December 2018,42 patients survived,with median progression-free survival(PFS)of 22 months and median overall survival(OS)of 60 months.The 3-and 5-year survival rate of the entire cohort was 68.6% and 46.4%,respectively.The median OS of patients with ASCT was not reached,and 5-year survival ratios was 83.9%.5.In univariate analysis,thrombocytopenia were the adverse prognostic factors for PFS and OS in patients aged 45 years and younger;Ig D MM and EMD were the adverse factors for PFS;ASCT was a favorable factor for PFS;high serum C-reactive protein level,elevated corrected serum calcium,and elevated LDH levels were unfavorable factors for OS.In multivariate analysis,ASCT can delay disease progression in MM patients;thrombocytopenia and lytic bone lesions ?3 were the independent risk factors of OS.Conclusions:1.MM patients aged 45 years and younger are rare,with clinical features including severe lytic lesions,high tumor burden and advanced disease.A high proportion of young patients commonly presented with light chain MM,Ig D MM and extramedullary disease.High frequencies of RB1 deletion,1q21 amplification and IGH rearrangement was observed.2.The benefit of response and survival with bortezomib-based regimens was favorable,and ASCT can delay disease progression in young adult MM patients,which is first-line choices for clinical treatment.3.Multivariate analysis revealed that thrombocytopenia and lytic bone lesions ?3 were the independent risk factors of OS;ASCT can delay disease progression in MM patients.