He JingSong, Yue XiaoYan, He DongHua, Zhao Yi, Yang Yang, Zheng GaoFeng, Zhang Enfan, Han XiaoYan, Wu WenJun, Yang Li, Chen Jing, Cai Zhen
Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Institute of Hematology, Zhejiang University, Hangzhou, China.
Front Oncol. 2021 Jul 7;11:668099. doi: 10.3389/fonc.2021.668099. eCollection 2021.
Extramedullary (EM) lesions are common in multiple myeloma (MM) and are often related to the poor prognosis of MM but are scarcely understood.
In this retrospective study, the baseline characteristics of 357 newly diagnosed patients with extramedullary multiple myeloma (EMM) and their impact on the prognosis were analyzed. All patients received first-line treatment with bortezomib-based regimen.
The overall incidence rate of EM was 22.4%, and the detection rate of PET/CT was significantly higher than other imaging methods (P = 0.015). The cohorts consisted of 10 cases of extramedullary extraosseous (EME) and 70 cases of extramedullary-bone related (EMB), including 53 cases with single site involvement (one case with EME) and 27 cases with multiple sites (>1 site) involvement (nine cases with EME). EMM patients had high levels of hemoglobin (Hgb, ≥10 g/dl) and serum lactate dehydrogenase (LDH, >245u/L) and are inclined to early-stage revised international staging system (R-ISS). Compared to patients without EM, those with EMM had worse progression-free survival (PFS) (P = 0.014) and overall survival (OS) (P = 0.032). In addition, patients without EM and those with a single site of EMB had similar PFS and OS, while patients with multiple sites of EMB or EME and multiple sites of EMB with EME had poor PFS and OS. Multivariate analysis confirmed that multiple sites of EMB and/or EME were independent prognostic predictors affecting PFS and OS in newly diagnosed MM patients.
This study suggested that among patients treated with bortezomib-based regimens, multiple sites of EMB and/or EME are independent poor prognostic factors for newly diagnosed MM patients, while a single site of EMB does not affect the survival of newly diagnosed MM patients. Thus, these findings could be used as a reference for the study of EMM patients in the new drug era, but prospective clinical studies are needed to provide evidence-based data for the diagnosis and treatment of EMM.
髓外（EM）病变在多发性骨髓瘤（MM）中很常见，且常与MM的不良预后相关，但人们对此了解甚少。
在这项回顾性研究中，分析了357例新诊断的髓外多发性骨髓瘤（EMM）患者的基线特征及其对预后的影响。所有患者均接受以硼替佐米为基础方案的一线治疗。
EM的总体发生率为22.4%，PET/CT的检出率显著高于其他影像学方法（P = 0.015）。该队列包括10例髓外骨外（EME）和70例髓外骨相关（EMB）病例，其中53例为单部位受累（1例EME），27例为多部位（>1个部位）受累（9例EME）。EMM患者血红蛋白（Hgb，≥10 g/dl）和血清乳酸脱氢酶（LDH，>245u/L）水平较高，且倾向于早期修订国际分期系统（R-ISS）。与无EM的患者相比，EMM患者的无进展生存期（PFS）更差（P = 0.014），总生存期（OS）也更差（P = 0.032）。此外，无EM的患者与单部位EMB患者的PFS和OS相似，而多部位EMB或EME以及多部位EMB合并EME的患者PFS和OS较差。多因素分析证实，多部位EMB和/或EME是影响新诊断MM患者PFS和OS的独立预后预测因素。
本研究表明，在接受以硼替佐米为基础方案治疗的患者中，多部位EMB和/或EME是新诊断MM患者独立的不良预后因素，而单部位EMB不影响新诊断MM患者的生存。因此，这些发现可为新药时代EMM患者的研究提供参考，但需要前瞻性临床研究为EMM的诊断和治疗提供循证数据。
