P-126: Characteristics and outcomes of patients with Multiple Myeloma aged ≤ 40 years – Experience from a Tertiary Care Cancer Centre in India

Introduction: MM primarily being a disease of elderly, the data among young patients are limited. It is essential to describe the presenting features, characteristics and outcomes of MM patients ≤40 years.

Methods: We analysed data of newly diagnosed Multiple Myeloma patients ≤40 years over 9 years from January 2013 to December 2021.

Results: A total of 110 patients diagnosed with Multiple Myeloma were analysed out of the total 1980 patients screened (Incidence 5.5%). At the time of analysis 48 patients were alive, 15 patients were dead and 47 patients were lost to follow up. The median age of the cohort was 36 years with Male to female ratio of 3:1. Clinically significant anaemia, hypercalcemia, renal impairment and hypoalbumenia were seen in 42.7%, 11.9%, 17.3% and 41.8% of patients respectively. Extramedullary plasmacytoma was seen in 9% of patients. Multiple lytic lesions were seen in 88.9% and single lytic lesion was seen in 3.7% of patients. According to International Staging System 35.5%, 27.1% and 37.4% of patients were in stage I, II and III respectively and according to Revised International Staging System 24%, 69.8% and 6.3% of patients were in stage I, II and III respectively. According to mSMART 78.3% of patients were standard risk and 21.7% of patients were high risk. LCD was diagnosed in 21.6% of patients. 38.5% of patients received VRD and 55% of patients received VCD as first line induction chemotherapy. According to IMWG response assessment CR, VGPR, PR were seen in 11.8%, 60.2%, 25.8% of patients respectively. Among the 64 patients who received maintenance, proteasome inhibitors were given to 20.3% and IMiDs were given to 48.4% of patients. 27% of patients received ASCT. After a median follow up of 44.2 months mPFS was 45.9 months. 1 year, 3 year and 5 year overall survival rates were 93.9%, 91.1% and 81.2% respectively. 3 year OS rates of patients who received and did not receive maintenance therapy were 97.4% and 86.1% respectively (p 0.0052). 3 year PFS rate of patients who received and did not receive maintenance were 80.2% and 42.1% respectively (p < 0.0001). Among patients who received PI and IMiD, 3 year PFS rates were 83.9% and 78.7% respectively. 5 year PFS of patients who received ASCT were 58.5 and for those who did not receive ASCT were 27.8% ( p 0.0043) and 5 year OS of patients who received and did not receive ASCT were 94.4% and 84.4% (p 0.031).

Conclusions:
Young patients accounted for 5.5% of all patients diagnosed with multiple myeloma. Younger patients presented with anaemia in approximately half and renal failure in about one fifth of patients. One fourth of patients had high risk cytogenetics. VCD and VRD are the commonly used first line regimens and ASCT was done in approximately one fourth of patients. Anaemia, Renal failure, poor performance status, HR cytogenetics, VCD compared to VRD, poor response to therapy, no maintenance therapy and no ASCT showed poor progression free survival.