PRESENTING FEATURES AND PROGNOSIS IN 72 PATIENTS WITH MULTIPLE-MYELOMA WHO WERE YOUNGER THAN 40 YEARS

The purpose of this study was to analyse the presenting clinical and l aboratory features and the outcome of 72 patients with multiple myelom a (MM) who were younger than 40 years. The records of all Mayo Clinic patients with MM younger than 40 years who were seen between 1 January 1956 and 31 December 1992 were reviewed. Survival was measured from t he date when treatment was required to the date of last follow-up or d eath. The frequency of MM in patients younger than 40 and 30 years in 3278 Mayo Clinic patients was 2.2% and 0.3%, respectively. The main pr esenting clinical features were bone pain (66%), fatigue (26%), extram edullary plasmacytomas (19%) and bacterial infection (11%). Renal func tion impairment (creatinine level greater than or equal to 177 mu mol/ l) and hypercalcaemia (serum calcium value greater than or equal to 2. 75 mmol/l) occurred in 29% and 30% of patients, respectively, Among th e 57 patients evaluable for response the objective response rate was 5 4%. 14/35 patients treated with a single alkylating agent achieved an objective response, whereas 17/22 patients given combination chemother apy had an objective response (P = 0.013). However, this higher respon se rate did not result in a significantly longer survival. The median survival for the 72 patients was 54 months. Patients with good prognos tic features (normal renal function or low beta(2)-microglobulin level ) had a median survival of 8 years. The actuarial survival at 5 and 10 years after initiation of therapy was 43% and 13%, respectively. In s ummary, survival in very young patients with myeloma is longer than th at observed in series of patients of all ages, especially in those wit h good prognostic factors.