TOPLINE:

Male patients with newly diagnosed multiple myeloma present with more advanced disease, showing twofold higher odds for International Staging System stage III disease and greater end-organ damage than female patients. Age influences these sex-based differences, with younger men (≤ 60 years) showing distinct patterns in free light chain ratios and chromosomal abnormalities.

METHODOLOGY:

• Male sex is recognized as an important risk factor for multiple myeloma, but differences in clinical presentation between men and women are poorly understood in newly diagnosed multiple myeloma.
• Researchers analyzed 850 patients with newly diagnosed multiple myeloma enrolled in the Integrative Molecular and Genetic Epidemiology study at the University of Alabama at Birmingham between 2009 and 2020.
• Analysis included evaluation of sex differences in clinical features and chromosomal abnormalities using prevalence odds ratios (ORs) and corresponding 95% CIs from logistic regression adjusted for confounders.
• Molecular characterization of cytogenetic abnormalities was performed on CD138 purified plasma cells from bone marrow aspirates in 634 (74.6%) patients before treatment.
• Diagnostic criteria followed the revised International Multiple Myeloma Working Group classification using SLIM-CRAB criteria, with cases reviewed by an expert panel for consistency.

TAKEAWAY:

• Male patients showed significantly higher odds for International Staging System stage III disease (OR, 2.05; 95% CI, 1.22-3.46; P = .007) and elevated serum monoclonal protein > 3 g/dL (OR, 1.72; 95% CI, 1.15-2.56; P = .008).
• Men demonstrated increased risk for end-organ damage (OR, 1.24; 95% CI, 1.02-1.50; P = .03), particularly renal impairment (OR, 1.71; 95% CI, 1.12-2.61; P = .01) and lytic lesions (OR, 1.97; 95% CI, 1.01-3.85; P = .05).
• Significant age-related interactions were observed in men regarding involved to uninvolved free light chain ratio > 100 (P = .01) and copy number abnormalities (P = .04).
• Female patients showed higher prevalence of light chain-only disease (OR, 0.63; 95% CI, 0.41-0.95; P = .03) and osteopenia (OR, 0.59; 95% CI, 0.36-0.98; P = .04).

IN PRACTICE:

“These novel findings suggest that male patients with newly diagnosed [multiple myeloma] have a greater tumor burden. To our knowledge, our findings are the first to provide evidence that men present at diagnosis with clinical features consistent with greater tumor burden, and that age is an important driver for select pathologic genomic events that differ at the presentation of disease by sex,” the authors of the study wrote.

SOURCE:

This study was led by Krystle L. Ong, PhD, Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham. It was published online in Cancer.

LIMITATIONS:

According to the authors, the sample size was relatively small, which limited the ability to define precise relationships, particularly for clinical features and genomic events occurring at low frequencies. This limitation was further affected when conducting formal tests for interactions by age. Additionally, molecular characterization was unavailable for approximately 25% of patients, partly due to recent additions of specific probes and inconsistencies across clinical laboratories in isolating CD138 cells from bone marrow aspirates.

DISCLOSURES:

This study received support from the National Cancer Institute through grants RO1 CA300518, U01 CA249955, and RO1 CA186646, as well as from the O’Neal Comprehensive Cancer Center Support Grant P30 CA13148. Additional funding was provided by the American Cancer Society Grant IRG60-001-47 and the National Institute for Allergy and Infectious Diseases Grant T32 AI007051.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.