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.