Haematologica. 2014 Feb;99(2):360-4. doi: 10.3324/haematol.2013.094409. Epub 2013 Sep 13.
Even in the era of new drugs, multiple myeloma patients with extramedullary relapse have a poor prognosis. Our goal was to analyze the frequency and outcome of extramedullary relapse occurring in relapsed multiple myeloma patients. In total, we analyzed the prognosis of 226 relapsed multiple myeloma patients treated between 2005 and 2008 and evaluated them for presence of extramedullary relapse. We found evidence of extramedullary relapse in 24% (55 of 226) of relapsed multiple myeloma patients. In 14% (32 of 226) of patients, the lesions were not adjacent to the bone, while extramedullary relapse adjacent to the bone was documented in 10% (23 of 226) of cases. Patients without extramedullary relapse had significantly longer overall survival than patients with extramedullary relapse (109 vs. 38 months; P<0.001). Moreover, patients with soft tissue-related extramedullary relapse had significantly poorer overall survival compared to bone-related extramedullary relapse patients (30 vs. 45 months; P=0.022). Also, overall survival from diagnosis was as low as five months for soft tissue-related extramedullary relapse patients when compared to 12 months overall survival for bone-related extramedullary relapse. This is the first study that shows a significant difference in prognosis for different types of extramedullary relapse. If the extramedullary myeloma infiltration was not bone-related, overall survival after relapse was extremely short (5 months).
即使在新药时代，有髓外复发的多发性骨髓瘤患者预后仍较差。我们的目标是分析复发多发性骨髓瘤患者髓外复发的频率和结果。我们分析了 2005 年至 2008 年期间治疗的 226 例复发多发性骨髓瘤患者的预后，并评估了他们是否有髓外复发。我们发现 226 例复发多发性骨髓瘤患者中有 24%（55 例）存在髓外复发。在 14%（32 例）的患者中，病变不邻近骨骼，而 10%（23 例）的病例有邻近骨骼的髓外复发。无髓外复发的患者总生存期明显长于有髓外复发的患者（109 个月与 38 个月；P<0.001）。此外，软组织相关髓外复发患者的总生存期明显短于骨相关髓外复发患者（30 个月与 45 个月；P=0.022）。与骨相关髓外复发患者 12 个月的总生存期相比，软组织相关髓外复发患者的总生存期从诊断开始就低至 5 个月。这是第一项表明不同类型髓外复发的预后存在显著差异的研究。如果髓外骨髓瘤浸润与骨骼无关，则复发后的总生存期极短（5 个月）。
