Introduction: Multiple myeloma (MM) is uncommon in persons younger than 50 years of age. The presenting features in this age group are unclear. Methods: We analyzed a cohort of patients <50 years of age with MM treated in our center. Results: Twenty-three patients at a median age of 41.5 years (range 27–49) were analyzed. Patients presented at International Staging System (ISS) I–II (79%), had high frequency of bone lytic lesions (89%), extramedullary disease (26%), light-chain myeloma (45%), and translocation t(11;14) (68%). The subpopulation of patients carrying t(11;14) were younger (p = 0.025). This subgroup had higher bone marrow infiltration of plasma cells (75 vs. 47.5%), higher incidence of proteinuria (2.9 vs. 0.19 g/day), and poorer response to therapy: 85.7% of patients achieving complete/very good partial remission after induction therapy did not have t(11;14). A trend toward inferior progression-free survival (PFS) was observed in patients with t(11; 14) compared to patients without this translocation (median PFS 18 and 36 months, respectively). Discussion/Conclusion: Translocation t(11; 14) seems to be more prevalent in young myeloma patients. Young myeloma patients and especially those who harbor translocation t(11; 14) may represent a distinct clinical entity that confers a poor outcome.

1.
Raab
MS
,
Podar
K
,
Breitkreutz
I
,
Richardson
PG
,
Anderson
KC
.
Multiple myeloma
.
Lancet
.
2009
Jul
;
374
(
9686
):
324
39
.
[PubMed]
0140-6736
2.
Weiss
BM
,
Abadie
J
,
Verma
P
,
Howard
RS
,
Kuehl
WM
.
A monoclonal gammopathy precedes multiple myeloma in most patients
.
Blood
.
2009
May
;
113
(
22
):
5418
22
.
[PubMed]
0006-4971
3.
Kyle
RA
,
Gertz
MA
,
Witzig
TE
,
Lust
JA
,
Lacy
MQ
,
Dispenzieri
A
, et al
Review of 1027 patients with newly diagnosed multiple myeloma
.
Mayo Clin Proc
.
2003
Jan
;
78
(
1
):
21
33
.
[PubMed]
0025-6196
4.
Kyle
RA
,
Therneau
TM
,
Rajkumar
SV
,
Offord
JR
,
Larson
DR
,
Plevak
MF
, et al
A long-term study of prognosis in monoclonal gammopathy of undetermined significance
.
N Engl J Med
.
2002
Feb
;
346
(
8
):
564
9
.
[PubMed]
0028-4793
5.
Kyle
RA
,
Therneau
TM
,
Rajkumar
SV
,
Larson
DR
,
Plevak
MF
,
Offord
JR
, et al
Prevalence of monoclonal gammopathy of undetermined significance
.
N Engl J Med
.
2006
Mar
;
354
(
13
):
1362
9
.
[PubMed]
0028-4793
6.
Rajkumar
SV
,
Landgren
O
,
Mateos
MV
.
Smoldering multiple myeloma
.
Blood
.
2015
May
;
125
(
20
):
3069
75
.
[PubMed]
0006-4971
7.
Rajkumar
SV
,
Gupta
V
,
Fonseca
R
,
Dispenzieri
A
,
Gonsalves
WI
,
Larson
D
, et al
Impact of primary molecular cytogenetic abnormalities and risk of progression in smoldering multiple myeloma
.
Leukemia
.
2013
Aug
;
27
(
8
):
1738
44
.
[PubMed]
0887-6924
8.
Neben
K
,
Jauch
A
,
Hielscher
T
,
Hillengass
J
,
Lehners
N
,
Seckinger
A
, et al
Progression in smoldering myeloma is independently determined by the chromosomal abnormalities del(17p), t(4;14), gain 1q, hyperdiploidy, and tumor load
.
J Clin Oncol
.
2013
Dec
;
31
(
34
):
4325
32
.
[PubMed]
0732-183X
9.
Corso
A
,
Klersy
C
,
Lazzarino
M
,
Bernasconi
C
.
Multiple myeloma in younger patients: the role of age as prognostic factor
.
Ann Hematol
.
1998
Feb
;
76
(
2
):
67
72
.
[PubMed]
0939-5555
10.
Bladé
J
,
Kyle
RA
,
Greipp
PR
.
Presenting features and prognosis in 72 patients with multiple myeloma who were younger than 40 years
.
Br J Haematol
.
1996
May
;
93
(
2
):
345
51
.
[PubMed]
0007-1048
11.
Ludwig
H
,
Durie
BG
,
Bolejack
V
,
Turesson
I
,
Kyle
RA
,
Blade
J
, et al
Myeloma in patients younger than age 50 years presents with more favorable features and shows better survival: an analysis of 10 549 patients from the International Myeloma Working Group
.
Blood
.
2008
Apr
;
111
(
8
):
4039
47
.
[PubMed]
0006-4971
12.
Rajkumar
SV
,
Dimopoulos
MA
,
Palumbo
A
,
Blade
J
,
Merlini
G
,
Mateos
MV
, et al
International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma
.
Lancet Oncol
.
2014
Nov
;
15
(
12
):
e538
48
.
[PubMed]
1470-2045
13.
Greipp
PR
,
San Miguel
J
,
Durie
BG
,
Crowley
JJ
,
Barlogie
B
,
Bladé
J
, et al
International staging system for multiple myeloma
.
J Clin Oncol
.
2005
May
;
23
(
15
):
3412
20
.
[PubMed]
0732-183X
14.
Shimoni
A
,
Nagler
A
,
Kaplinsky
C
,
Reichart
M
,
Avigdor
A
,
Hardan
I
, et al
Chimerism testing and detection of minimal residual disease after allogeneic hematopoietic transplantation using the bioView (Duet) combined morphological and cytogenetical analysis
.
Leukemia
.
2002
Aug
;
16
(
8
):
1413
8
.
[PubMed]
0887-6924
15.
Trakhtenbrot
L
,
Hardan
I
,
Koren-Michowitz
M
,
Oren
S
,
Yshoev
G
,
Rechavi
G
, et al
Correlation between losses of IGH or its segments and deletions of 13q14 in t(11;14) (q13;q32) multiple myeloma
.
Genes Chromosom Cancer
;
2010
.
16.
Durie
BG
,
Harousseau
JL
,
Miguel
JS
,
Bladé
J
,
Barlogie
B
,
Anderson
K
, et al;
International Myeloma Working Group
.
International uniform response criteria for multiple myeloma
.
Leukemia
.
2006
Sep
;
20
(
9
):
1467
73
.
[PubMed]
0887-6924
17.
Hansford
BG
,
Silbermann
R
.
Advanced Imaging of Multiple Myeloma Bone Disease
.
Front Endocrinol (Lausanne)
.
2018
Aug
;
9
:
436
.
[PubMed]
1664-2392
18.
Bladé
J
,
Fernández de Larrea
C
,
Rosiñol
L
,
Cibeira
MT
,
Jiménez
R
,
Powles
R
.
Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach
.
J Clin Oncol
.
2011
Oct
;
29
(
28
):
3805
12
.
[PubMed]
0732-183X
19.
Rafae
A
,
Malik
MN
,
Abu Zar
M
,
Durer
S
,
Durer
C
.
An Overview of Light Chain Multiple Myeloma: Clinical Characteristics and Rarities, Management Strategies, and Disease Monitoring
.
Cureus
.
2018
Aug
;
10
(
8
):
e3148
.
[PubMed]
2168-8184
20.
Landgren
O
,
Kyle
RA
,
Pfeiffer
RM
,
Katzmann
JA
,
Caporaso
NE
,
Hayes
RB
, et al
Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study
.
Blood
.
2009
May
;
113
(
22
):
5412
7
.
[PubMed]
0006-4971
21.
Avet-Loiseau
H
,
Attal
M
,
Moreau
P
,
Charbonnel
C
,
Garban
F
,
Hulin
C
, et al
Genetic abnormalities and survival in multiple myeloma: the experience of the Intergroupe Francophone du Myélome
.
Blood
.
2007
Apr
;
109
(
8
):
3489
95
.
[PubMed]
0006-4971
22.
Fonseca
R
,
Blood
EA
,
Oken
MM
,
Kyle
RA
,
Dewald
GW
,
Bailey
RJ
, et al
Myeloma and the t(11;14)(q13;q32); evidence for a biologically defined unique subset of patients
.
Blood
.
2002
May
;
99
(
10
):
3735
41
.
[PubMed]
0006-4971
23.
Leiba
M
,
Duek
A
,
Amariglio
N
,
Avigdor
A
,
Benyamini
N
,
Hardan
I
, et al
Translocation t(11;14) in newly diagnosed patients with multiple myeloma: Is it always favorable?
Genes Chromosom Cancer
;
2016
.
24.
Bochtler
T
,
Hegenbart
U
,
Kunz
C
,
Granzow
M
,
Benner
A
,
Seckinger
A
, et al
Translocation t(11;14) is associated with adverse outcome in patients with newly diagnosed AL amyloidosis when treated with bortezomib-based regimens
.
J Clin Oncol
.
2015
Apr
;
33
(
12
):
1371
8
.
[PubMed]
0732-183X
25.
Pawlyn
C
,
Melchor
L
,
Murison
A
,
Wardell
CP
,
Brioli
A
,
Boyle
EM
, et al
Coexistent hyperdiploidy does not abrogate poor prognosis in myeloma with adverse cytogenetics and may precede IGH translocations
.
Blood
.
2015
Jan
;
125
(
5
):
831
40
.
[PubMed]
0006-4971
26.
Lakshman
A
,
Alhaj Moustafa
M
,
Rajkumar
SV
,
Dispenzieri
A
,
Gertz
MA
,
Buadi
FK
, et al
Natural history of t(11;14) multiple myeloma
.
Leukemia
.
2018
Jan
;
32
(
1
):
131
8
.
[PubMed]
0887-6924
27.
Kumar
S
,
Kaufman
JL
,
Gasparetto
C
,
Mikhael
J
,
Vij
R
,
Pegourie
B
, et al
Efficacy of venetoclax as targeted therapy for relapsed/refractory t(11;14) multiple myeloma
.
Blood
.
2017
Nov
;
130
(
22
):
2401
9
.
[PubMed]
0006-4971
28.
Matulis
SM
,
Gupta
VA
,
Nooka
AK
,
Hollen
HV
,
Kaufman
JL
,
Lonial
S
, et al
Dexamethasone treatment promotes Bcl-2 dependence in multiple myeloma resulting in sensitivity to venetoclax
.
Leukemia
.
2016
May
;
30
(
5
):
1086
93
.
[PubMed]
0887-6924
29.
Punnoose
EA
,
Leverson
JD
,
Peale
F
,
Boghaert
ER
,
Belmont
LD
,
Tan
N
, et al
Expression Profile of BCL-2, BCL-XL, and MCL-1 Predicts Pharmacological Response to the BCL-2 Selective Antagonist Venetoclax in Multiple Myeloma Models
.
Mol Cancer Ther
.
2016
May
;
15
(
5
):
1132
44
.
[PubMed]
1535-7163
30.
Moreau
P
,
Chanan-Khan
A
,
Roberts
AW
,
Agarwal
AB
,
Facon
T
,
Kumar
S
, et al
Promising efficacy and acceptable safety of venetoclax plus bortezomib and dexamethasone in relapsed/refractory MM
.
Blood
.
2017
Nov
;
130
(
22
):
2392
400
.
[PubMed]
0006-4971
31.
Leverson
JD
,
Sampath
D
,
Souers
AJ
,
Rosenberg
SH
,
Fairbrother
WJ
,
Amiot
M
, et al
Found in Translation: How Preclinical Research Is Guiding the Clinical Development of the BCL2-Selective Inhibitor Venetoclax
.
Cancer Discov
.
2017
Dec
;
7
(
12
):
1376
93
.
[PubMed]
2159-8274
32.
Touzeau
C
,
Le Gouill
S
,
Mahé
B
,
Boudreault
JS
,
Gastinne
T
,
Blin
N
, et al
Deep and sustained response after venetoclax therapy in a patient with very advanced refractory myeloma with translocation t(11;14)
.
Haematologica
.
2017
Mar
;
102
(
3
):
e112
4
.
[PubMed]
0390-6078
33.
Billecke
L
,
Murga Penas
EM
,
May
AM
,
Engelhardt
M
,
Nagler
A
,
Leiba
M
, et al
Cytogenetics of extramedullary manifestations in multiple myeloma
.
Br J Haematol
.
2013
Apr
;
161
(
1
):
87
94
.
[PubMed]
0007-1048
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