As more and more people in their 20s and 30s begin to receive diagnoses of multiple myeloma, a type of blood cancer, one expert stresses that continued research to improve survival in this patient population is critical.
As the multiple myeloma patient population is becoming younger, more aggressive treatment may be warranted to improve survival in patients in their 20s and 30s. But researchers and oncologists alike question why this trend of younger patients is continuing.
The risk for developing multiple myeloma increases as patients age. According to the American Society of Clinical Oncology, the average age a patient is diagnosed with multiple myeloma is 70. In addition, the National Cancer Institute estimated that there would be approximately 35,000 new cases of multiple myeloma in 2021, of which approximately 1,500 to 2,000 cases would be in patients in their 30s and 40s.
Dr. Cristina Gasparetto, a professor of medicine at Duke University School of Medicine and director of the Multiple Myeloma Program at Duke Health in Durham, North Carolina, recalled treating a “fair amount of younger patients” over the past 20 years, with the youngest being 19 years old.
She has also treated patients in their mid-20s and -30s, as well as pregnant women.
“It’s always very interesting because if you read the (data) about multiple myeloma, the median age of diagnosis used to be in the 70s when I was in the beginning of my (career),” Gasparetto said. “It was clearly a disease of the elderly.”
As the median age at first diagnosis of multiple myeloma decreases over time, oncologists like Gasparetto are left wondering why this is occurring.
“It’s always been unclear to me if it was a culmination of a genetic predisposition and environmental toxin exposure,” she said. “I don’t think we have a lot of research in this population of patients, so we don’t know much (about the reasons why).”
Researchers recently published study findings in the journal Blood, in which they assessed outcomes over a 15-year period in 214 patients diagnosed with multiple myeloma at age 40 and younger. Younger patients with multiple myeloma had similar disease characteristics to older patients.
Regarding treatment, 90% of younger patients received intensive chemotherapy then autologous stem cell transplant, and 25% of patients underwent an allogenic stem cell transplant when they relapsed.
“I was very surprised by the number (of patients who) had the allogenic transplant,” said Gasparetto, who is not associated with this study. “It’s a huge number because we don’t offer this type of approach very often.”
Younger patients in the study had a median overall survival (the time a patient with multiple myeloma is still alive) of 14.5 years.
“If you look at the projected survival of this population, a patient definitely (has) higher (survival) than (those in) the older population,” said Gasparetto. “The median overall survival was 14 years, which is much higher than we projected for the older patients. (For those who are) 60-plus, (it’s) shorter than 10 years.”
Gasparetto added that this difference in overall survival between younger and older patients may be due to more aggressive treatment, especially as younger patients may be able to tolerate it better than older patients.
Younger patients in the study also had a median progression-free survival (the time after treatment when a patient lives with multiple myeloma without disease progression) of 41 months.
“Now we can keep their disease at bay for a longer period of time,” Gasparetto said. “We probably treat them longer and more aggressively. … If you look at the percentage of patients that we’re treating (at) the time of diagnosis versus later lines of therapy, (progression-free survival) goes down tremendously (in older patients) because we lose patients to myeloma, they can’t tolerate the toxicity (or they have) other comorbidities. In this younger population of patients, we probably can keep treating them for years, and they sustain therapy much longer.”
Gasparetto has some personal experience with the aggressive treatment of younger patients with multiple myeloma in her clinic.
One patient, who was in their 20s at the time of diagnosis, was treated aggressively with transplant, consolidation (treatment given for a short time) and maintenance regimens (given for one to two years to keep multiple myeloma in remission and potentially prevent relapse), among other tactics that Gasparetto referred to as “outside the box because … back then, we were not doing that.”
The patient is now in their 40s, married with two children and with a career.
She also recalled another patient whom she treated with three transplants when they were diagnosed at age 34. That patient is currently 50 years old and serving as a multiple myeloma advocate to spread awareness.
“You keep them alive,” Gasparetto said. “I know that I keep manipulating his myeloma, his graft and doing things. It’s something that you were capable of doing because they’re young and they’re sustaining therapy. This is fascinating. He always fascinated me because I have a weak spot for younger patients because myeloma can take life away. It can take (away) their dreams, their future. And I always felt like no, no, no, we need to be more aggressive. We need to treat them differently.”
Gasparetto offered some advice for younger patients diagnosed with multiple myeloma.
“You have to be careful to understand your disease, understand that it’s a very difficult disease to live with (and that) relying on the guidance of a physician will span (your) entire life. (You need to) understand that unfortunately, (multiple myeloma) is going to affect your quality of life, but we might be able to prolong your life.”
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