MULTIPLE-MYELOMA IN YOUNGER PATIENTS - THE ROLE OF AGE AS PROGNOSTIC FACTOR

The presenting features of 356 previously untreated multiple myeloma ( MM) patients grouped according to age were analyzed in order (a) to el ucidate the possible differences in initial clinical and laboratory fe atures between patients younger than 50 years and the older ones and ( b) to statistically assess the prognostic value of the parameters cons idered, with particular emphasis on the prognostic impact of age. Pati ents were divided into two groups: group I included 61 patients aged l ess than 50, group II comprised 295 patients aged 50 or more. No signi ficant differences were found between the two groups in terms of eithe r clinical or laboratory initial characteristics. The treatments adopt ed and the response to therapy did not differ in the two groups. The p rognostic value of presenting features was evaluated for the whole coh ort by univariate and multivariate analysis, considering both the ob s erved survival rates and survival rates corrected for the effect of ot her independent causes of death, using a Poisson model. In both models , calcium level (RR 2.33), performance status (RR 1.83), and creatinin e (RR 1.69) maintained their independent negative prognostic value. In contrast, the impact of age was different in the two models. In fact, patients younger than 50 seem to have a better prognosis when the obs erved survival rates are considered, but they show an increased risk o f death when the model takes into account the expected mortality of th e underlying population. In conclusion, this study shows that the youn ger cohort of MM patients has no distinctive initial characteristics w ith respect to older patients. In multivariate analysis, creatinine le vels, calcemia, and performance status show a relevant negative indepe ndent prognostic value. Regarding the prognostic impact of age, surviv al seems to be better among patients younger than 50 than in older pat ients when the observed survival rates are considered but is significa ntly worse when the mortality of the corresponding general population. is taken into account.