POSTER 45
MULTIPLE MYELOMA IN YOUNG ADULTS: A REPORT OF NINE CASES
Dr. Saikumar Soman1, Dr. Geetha Narayanan2, Dr. Sreejith N Nair3, Dr. Prakash NP3, Dr Anoop TM4, Dr
Sugeeth MT5 and Dr Priya Mary Jacob6
(1)Senior resident Department of Medical Oncology RCC, Thiruvananthapuram, India
(2)Professor and Head of the department , Department of Medical Oncology, RCC,
Thiruvananthapuram, India
(3)Additional Professor Department of Medical Oncology RCC, Thiruvananthapuram, India
(4)Associate Professor Department of Medical Oncology RCC, Thiruvananthapuram, India
(5)Assistant Professor Department of Medical Oncology RCC, Thiruvananthapuram, India
(6)Assistant Professor Department of Pathology RCC, Thiruvananthapuram, India
Objectives: To Study clinical presentation, diagnosis, treatment received and survival of multiple
myeloma patients under 30 years of age.
Material & Methods: This is a retrospective study of 9 patients diagnosed with multiple myeloma who
were under 30 years of age, treated at Regional Cancer Centre, Trivandrum, during 10 year period from
2008 to 2018. The case records of the patients were studied with respect to clinical presentation,
diagnosis, treatment received and survival.
Results: The median age at presentation was 28 years (range 25-30 years).There were 6 males and 3
females. Bone pain was the most common presenting symptom which was seen in 5 patients. Other
presenting symptoms were fatigue, excertional dypsnoea and decreased urine output. Two patients
presented with extraskeletal deposits. Bone lytic lesions and anaemia were seen in 7 patients each. All
patients were staged using international staging system (ISS), five patients were in ISS-III, two were
ISS-II and one was ISS-I. Four patients had IgG kappa disease, three had IgG lambda and one had
lambda light chain disease. Lactate dehydrogenase (LDH) levels at presentation was elevated in all
patients.
Among the 9 patients, one patient expired before starting treatment due to sepsis and multi organ
failure. Six patients received three drug induction, five with BLD (Bortezomib, Lenalidomide
Dexamethasone), one with BTD (Bortezomib, Thalidomide, Dexamethasone), other two patients were
treated with Thalidomide -dexamethasone and Bortezomib- dexamethasone respectively. Four
patients received palliative radiation to their painful bone lesions. All patients tolerated induction
chemotherapy well. One patient reported grade3 peripheral neuropathy during the course of
treatment
After six months of induction chemotherapy three patients achieved a complete response, three had
very good partial response, one had partial response and two progressed after induction. Four patients
underwent autologous bone marrow transplant and two continues to be in remission. Among the
three patients who responded but didn’t undergo transplant, two have relapsed and died, one
continues to be in remission. In our series of 9 patients, the median OS is 4 years. Among 9 patients 5
patients expired due to disease progression, 4 patients were alive in remission with 22, 48, 70 and 143
months of overall survival respectively.
Conclusions: Young patients with multiple myeloma have aggressive course with poor outcome. In this
study only 4 patients (44%) survived more than 2 years. Autologous transplant can be considered as
consolidation in this patients.