Zhao Yongfeng, Zhou Fuling
Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
J Cancer Res Clin Oncol. 2023 Mar;149(3):995-1006. doi: 10.1007/s00432-022-03948-9. Epub 2022 Feb 25.
We aimed to compare the clinical characteristics, treatment efficacy and survival in patients with newly diagnosed multiple myeloma with single- versus multi-site extramedullary invasion.
A total of 90 extramedullary multiple myeloma (EMM) patients were included. We compared the characteristics, overall remission rates (ORRs) and survival among patients with single-site and multi-site invasions. Comparison was also done regarding extramedullary-bone-related (EM-B) and extramedullary-extraosseous (EM-E) multiple myeloma patients.
Patients with multi-site invasion had higher LDH (179.0 U/L) than single-site invasion (P = 0.016). Significantly higher LDH was also showed in patients with EM-E (189.4 U/L) than EM-B (P = 0.025). The ORR of patients with single-site invasion (72.1%) was not significantly higher than multi-site invasion (68.2%) (P = 0.690). But the ORR of patients with EM-B was significantly higher than EM-E (78.2 vs. 56.3%, P = 0.031). Among patients with single-site invasion, the multivariate survival analysis showed that PI plus IMiD regimen significantly improved the PFS (P < 0.05). Among patients with multi-site invasion or with EM-B, the multivariate survival analysis confirmed the associations of rISS III with poor PFS and OS (P < 0.05). Among patients with EM-E, plasma cell percentage ≥ 20% was associated with significantly poor PFS and OS (P < 0.05).
rISS stage III was possibly associated with poor survival of EMM patients with multi-site invasion or with EM-B. Plasma cell percentage ≥ 20% was associated with poor survival of EMM patients with EM-E. Comparison should not only be done between single- and multi-site invasions, but also between EM-B and EM-E.
我们旨在比较新诊断的多发性骨髓瘤患者单部位与多部位髓外侵犯的临床特征、治疗疗效和生存率。
共纳入90例髓外多发性骨髓瘤（EMM）患者。我们比较了单部位和多部位侵犯患者的特征、总缓解率（ORR）和生存率。还对髓外骨相关（EM-B）和髓外骨外（EM-E）多发性骨髓瘤患者进行了比较。
多部位侵犯患者的乳酸脱氢酶（LDH）水平（179.0 U/L）高于单部位侵犯患者（P = 0.016）。EM-E患者的LDH水平（189.4 U/L）也显著高于EM-B患者（P = 0.025）。单部位侵犯患者的ORR（72.1%）并不显著高于多部位侵犯患者（68.2%）（P = 0.690）。但EM-B患者的ORR显著高于EM-E患者（78.2%对56.3%，P = 0.031）。在单部位侵犯患者中，多因素生存分析显示PI加IMiD方案显著改善了无进展生存期（P < 0.05）。在多部位侵犯或EM-B患者中，多因素生存分析证实国际分期系统（rISS）III期与较差的无进展生存期和总生存期相关（P < 0.05）。在EM-E患者中，浆细胞百分比≥20%与显著较差的无进展生存期和总生存期相关（P < 0.05）。
rISS III期可能与多部位侵犯或EM-B的EMM患者的不良生存相关。浆细胞百分比≥20%与EM-E的EMM患者的不良生存相关。不仅应在单部位和多部位侵犯之间进行比较，还应在EM-B和EM-E之间进行比较。
