Can Multiple Myeloma (MM) occur in a 37-year-old?

Multiple Myeloma in a 37-Year-Old Patient

Yes, multiple myeloma (MM) can occur in a 37-year-old patient, although it is uncommon in this age group as the median age at diagnosis is between 65-70 years. 1

Epidemiology of MM in Young Patients

• Multiple myeloma accounts for approximately 1% of all cancers and 10% of all hematological malignancies 1
• The median age at diagnosis is between 65-70 years, with less than 10% of patients diagnosed between the second to fourth decades 1
• MM in patients younger than 40 years accounts for only about 2% of all myeloma cases 2
• Young patients with MM may represent a distinct clinical entity with specific characteristics 3

Clinical Presentation in Young Patients

• The presenting clinical and laboratory features in young patients are generally similar to those in older patients 2
• However, young patients may have some distinctive characteristics:
  • Higher frequency of light-chain myeloma (45% in patients <50 years) 3, 2
  • High frequency of bone lytic lesions (89% in patients <50 years) 3
  • Higher incidence of extramedullary disease (26% in patients <50 years) 3
  • Cytogenetic abnormalities such as translocation t(11;14) appear more prevalent in young myeloma patients 3

Diagnostic Approach

The diagnostic criteria for MM are the same regardless of age and require:

• ≥10% clonal plasma cells on bone marrow examination or a biopsy-proven plasmacytoma 1
• Evidence of end-organ damage (CRAB criteria) related to the plasma cell disorder:
  • C: Hypercalcemia (serum calcium >11.5 mg/dL)
  • R: Renal insufficiency (creatinine >2 mg/dL)
  • A: Anemia (hemoglobin <10 g/dL)
  • B: Bone lesions (lytic lesions on skeletal radiography, CT, or PET-CT) 1, 4

Essential Diagnostic Tests

• Serum and urine protein electrophoresis with immunofixation to detect and characterize monoclonal protein 4
• 24-hour urine collection for protein electrophoresis and immunofixation to detect Bence Jones proteins 5
• Serum free light chain assay with kappa/lambda ratio 4
• Bone marrow aspiration and biopsy with immunohistochemistry to establish clonality 4
• Imaging studies:
  • Full skeletal survey (X-rays) including spine, pelvis, skull, humeri, and femurs 4
  • MRI of spine and pelvis if symptoms suggest bone lesions even with negative X-rays 4
  • CT scan or PET scan may be needed for further evaluation 1, 4

Treatment Considerations in Young Patients

• Young patients (<65 years) in good clinical condition should be considered for high-dose therapy with autologous stem cell transplantation (ASCT) as the standard treatment 1
• Young patients with MM, particularly those with good prognostic features (normal renal function or low beta2-microglobulin level), tend to have longer survival than older patients 2
• Treatment approach should consider:
  • Cytogenetic risk stratification, as certain abnormalities like t(11;14) may confer poorer outcomes in young patients 3
  • Preservation of fertility if applicable
  • Long-term complications of therapy given the potentially longer survival 2

Prognosis

• Young patients with MM generally have better survival outcomes compared to older patients 2
• However, the disease remains incurable with conventional approaches 6
• Specific cytogenetic abnormalities, particularly translocation t(11;14) in young patients, may be associated with poorer outcomes 3
• With modern therapies including high-dose therapy and autologous stem cell transplantation, median survival can exceed 5 years 6

Important Considerations

• Do not delay diagnosis due to age-related bias - MM should be considered in the differential diagnosis of a young patient with compatible symptoms 3, 2
• Young patients with MM may benefit from early aggressive therapy and consideration for clinical trials 2
• Genetic counseling may be appropriate given the younger age of onset 7
• Long-term follow-up is essential as young patients may live longer with the disease and experience more treatment-related complications 2