Data Show Potentially Higher Disease Burden Among Male NDMM Population

Male patients with newly diagnosed multiple myeloma (NDMM) tend to present with clinical features that correlate with a heavier disease burden compared with female populations, according to data from the IMAGE study published in Cancer.¹

Based on multivariate analysis, patients who were male were more likely to have International Staging System (ISS) stage III disease at diagnosis (OR, 2.05; 95% CI, 1.22–3.46; P = .007), a high serum monoclonal protein (OR, 1.72; 95% CI, 1.15–2.56; P = .008), k light chain disease (OR, 1.60; 95% CI, 1.11–2.30; P = .01), and more end-organ damage (OR, 1.24; 95% CI, 1.02–1.50; P = .03) compared with patients who were female. When adjusting for various covariates including race, age, body mass index, and education, male populations with NDMM had a lower likelihood of presenting with 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).

Although additional analyses showed no significant associations between age and sex, the prevalence of most clinical features and chromosomal abnormalities among male populations was more pronounced in patients older than 60 years compared with younger male patients. Additionally, male patients who were 60 years or younger had a higher likelihood of experiencing k light chain disease (OR, 1.76; 95% CI, 1.02-3.05; P = .04) and ISS stage III disease (OR, 2.40; 95% CI, 1.08-5.34; P = .03) compared with older populations.

“This research suggests that sex-specific mechanisms promote multiple myeloma pathogenesis, which may account for the excess risk seen in men,” lead study author Krystle L. Ong, PhD, of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham (UAB), stated in a press release on these findings.² “These findings may be used to improve risk stratification, diagnosis, and tailored treatments for both men and women with newly diagnosed multiple myeloma or related early precursor conditions.”

Investigators enrolled 850 patients with NDMM from 2009 to 2020 and confirmed all cases based on revised and updated International Multiple Myeloma Working Group classification for multiple myeloma and SLiM-CRAB criteria. Patients 21 years and older under recruitment based on UAB Multidisciplinary Myeloma Clinic schedules.

The study involved systematically collecting diagnostic clinical features from medical history, physical examination, and pathology, laboratory, and radiology reports. Investigators determined how sex correlated with the prevalence of SLiM-CRAB criteria, other clinical features, and chromosomal abnormalities using logistic regression models.

Among 394 female and 456 male patients, most were White (51.78% vs 66.45%); the median age was 61 years (range, 27-85) and 62 years (range, 32-91) in each respective population. Across each respective cohort, most patients had no history of smoking (66.24% vs 50.66%), no history of drinking (75.83% vs 46.92%), and an annual household income of no more than $49,999 (64.71% vs 44.19%). The most common comorbidities among female and male patients, respectively, included hypertension (60.66% vs 59.21%), type 2 diabetes (19.29% vs 20.61%), hyperlipidemia (18.02% vs 27.19%), and solid tumors (12.44% vs 13.16%).

Among all patients, 96.1% (n = 817) had a diagnosis of NDMM per CRAB criteria, while 3.9% (n = 33) had diagnoses fulfilling SLiM criteria. Most patients whose disease aligned with CRAB-SLiM guidelines had heavy chain IgG isotype (57.66%) as well as IgA (21.07%) and IgM (0.24%).

“Our sample was small, prohibiting the ability to define precise relationships particularly for the clinical features and genomic events that occur at low frequencies, which was further diminished by formal tests for interactions by age,” the study authors wrote regarding the limitations of their analysis.¹ “Future studies that include larger populations may enable opportunities to evaluate the joint effect of early age of onset…and clinical characteristics on sex differences in patients with NDMM.”

References

1. Ong KL, Arnold KD, Wessel MC, et al. Sex differences in the clinical presentation of patients with newly diagnosed multiple myeloma. Cancer. 2026;132(2):e70192. doi:10.1002/cncr.70192
2. Why are men more likely to develop multiple myeloma than women? News release. Wiley. January 12, 2026. Accessed January 23, 2026. https://tinyurl.com/4uv5wv44