Hematogenous extramedullary relapse in multiple myeloma - a multicenter retrospective study in 127 patients.

Adult Aged Aged, 80 and over Antineoplastic Agents, Immunological / administration & dosage Antineoplastic Combined Chemotherapy Protocols / therapeutic use Autografts Bone Neoplasms / blood Central Nervous System / pathology Combined Modality Therapy Female Hematopoietic Stem Cell Transplantation Humans Immunologic Factors / administration & dosage Kaplan-Meier Estimate Liver / pathology Lung / pathology Lymph Nodes / pathology Male Middle Aged Multiple Myeloma / blood Neoplastic Cells, Circulating Neoplastic Stem Cells / pathology Organ Specificity Plasma Cells / pathology Plasmacytoma / blood Pleura / pathology Progression-Free Survival Proportional Hazards Models Proteasome Inhibitors / administration & dosage Recurrence Retrospective Studies Salvage Therapy / methods Skin / pathology

Journal

American journal of hematology

ISSN: 1096-8652

Titre abrégé: Am J Hematol

Pays: United States

ID NLM: 7610369

Informations de publication

Date de publication:
10 2019

Historique:

received: 13 04 2019

revised: 10 07 2019

accepted: 13 07 2019

pubmed: 25 7 2019

medline: 9 4 2020

entrez: 24 7 2019

Statut: ppublish

Résumé

The current study assesses the characteristics and outcomes of multiple myeloma (MM) patients, treated with novel agents for hematogenous extramedullary (HEMM) relapse. Consecutive patients diagnosed with HEMM between 2010-2018 were included. Patients' characteristics at diagnosis and at HEMM presentation, response to treatment, survival and factors predicting survival were recorded and analyzed. A group of 127 patients, all diagnosed with HEMM by imaging (87.3%) and/or biopsy (79%), were included. Of those, 44% were initially diagnosed with ISS3, 57% presented with plasmacytomas, and 30% had high-risk cytogenetics. Median time to HEMM was 32 months. In multivariate analysis, ISS3 and bone plasmacytoma predicted shorter time to HEMM (P = .005 and P = .008, respectively). Upfront autograft was associated with longer time to HEMM (P = .002). At HEMM, 32% of patients had no BM plasmacytosis, 20% had non-secretory disease and 43% had light-chain disease. Multiple HEMM sites were reported in 52% of patients, mostly involving soft tissue, skin (29%), and pleura/lung (25%). First treatment for HEMM included proteasome inhibitors (50%), immunomodulatory drugs (IMiDs) (39%), monoclonal antibodies (10%), and chemotherapy (53%). Overall response rate (ORR) was 57%. IMiDs were associated with higher ORR (HR 2.2, 95% CI 1.02-4.7, P = .04). Median survival from HEMM was 6 months (CI 95% 4.8-7.2). Failure to achieve ≥VGPR was the only significant factor for worse OS in multivariate analyses (HR = 9.87, CI 95% 2.35 - 39, P = .001). In conclusion, HEMM occurs within 3 years of initial myeloma diagnosis and is associated with dismal outcome. The IMiDs might provide a higher response rate, and achievement of ≥VGPR predicts longer survival.

Identifiants

DOI: 10.1002/ajh.25579 PMID: 31334859

pubmed: 31334859

doi: 10.1002/ajh.25579

doi:

Substances chimiques

Antineoplastic Agents, Immunological 0

Immunologic Factors 0

Proteasome Inhibitors 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

1132-1140

Informations de copyright

Références

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