Wang Ying, Liu Aijun, Xu Tingting, Yin Jiahui, Chen Wenming
Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, P.R. China.
Clin Med Insights Oncol. 2022 Jul 18;16:11795549221109500. doi: 10.1177/11795549221109500. eCollection 2022.
Bone-related extramedullary disease (EMD-B) is mass of clonal plasma cells derived from adjacent bone lesions and has obvious heterogeneities in clinical outcomes. This retrospective study aims to evaluate the treatment outcomes and long-term prognosis of newly diagnosed myeloma patients with EMD-B.
This was a retrospective study conducted in Beijing Chaoyang Hospital from January 1, 2010 to December 31, 2019. Seventy-seven newly diagnosed multiple myeloma patients with EMD-B were selected. Propensity score matching (1:2) was used to match patients with and without EMD-B. After matching, 132 patients without extramedullary disease (non-EMD) were included in the study. All patients received bortezomib-based regimens as induction therapy.
After matching, baseline data of the 2 groups were comparable. The Cox regression analysis of patients with EMD-B showed that age, paravertebral lesions, and immunoglobulin D (IgD) type may have adverse effects on survival. Bone-related extramedullary disease at new diagnosis was a risk predictor of survival (hazard ration [HR] = 1.80, 95% confidence interval [CI]: 1.09-2.98, = .022). The median survival time of the EMD-B group was significantly shorter than that of the non-EMD group (52 months vs 96 months, = .043). Induction therapy did not show any significant differences in effectiveness between the 2 groups. Autologous stem cell transplantation (ASCT) significantly increased complete remission rate of patients with EMD-B (EMD-B vs non-EMD: no ASCT 15.7% vs 31.9%, = .035; ASCT 42.3% vs 48.8%, = .626) and improved their median overall survival rate (EMD-B vs non-EMD: no ASCT 49 months vs 75 months, = .003; ASCT not reached vs 96 months, = .505).
This study demonstrated that newly diagnosed myeloma patients with EMD-B had poor outcomes, which could be improved by ASCT.
骨相关髓外疾病（EMD-B）是源自相邻骨病变的克隆性浆细胞团块，临床结局具有明显的异质性。本回顾性研究旨在评估新诊断的伴有EMD-B的骨髓瘤患者的治疗效果和长期预后。
这是一项于2010年1月1日至2019年12月31日在北京朝阳医院进行的回顾性研究。选取了77例新诊断的伴有EMD-B的多发性骨髓瘤患者。采用倾向评分匹配法（1:2）对伴有和不伴有EMD-B的患者进行匹配。匹配后，132例无髓外疾病（非EMD）的患者纳入研究。所有患者均接受以硼替佐米为基础的方案作为诱导治疗。
匹配后，两组的基线数据具有可比性。对EMD-B患者的Cox回归分析表明，年龄、椎旁病变和免疫球蛋白D（IgD）型可能对生存有不利影响。新诊断时的骨相关髓外疾病是生存的风险预测因素（风险比[HR]=1.80，95%置信区间[CI]：1.09-2.98，P=.022）。EMD-B组的中位生存时间显著短于非EMD组（52个月对96个月，P=.043）。诱导治疗在两组之间的有效性上未显示出任何显著差异。自体干细胞移植（ASCT）显著提高了EMD-B患者的完全缓解率（EMD-B组与非EMD组：未进行ASCT时为15.7%对31.9%，P=.035；进行ASCT时为42.3%对48.8%，P=.626），并改善了他们的中位总生存率（EMD-B组与非EMD组：未进行ASCT时为49个月对75个月，P=.003；进行ASCT时未达到对96个月，P=.505）。
本研究表明，新诊断的伴有EMD-B的骨髓瘤患者预后较差，ASCT可改善其预后。
