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Hematogenous extramedullary relapse in multiple myeloma ‐ a multicenter retrospective study in 127 patients
Author(s) -
Avivi Irit,
Cohen Yael C.,
Suska Anna,
Shragai Tamir,
Mikala Gabor,
Garderet Laurent,
Seny Gueye M.,
Glickman Sophia,
Jayabalan David S.,
Niesvizky Ruben,
Gozzetti Alessandro,
WiśniewskaPiąty Katarzyna,
WaszczukGajda Anna,
UsnarskaZubkiewicz Lidia,
Hus Iwona,
Guzicka Renata,
Radocha Jakub,
Milunovic Vibor,
Davila Julio,
Gentile Massimo,
Castillo Jorge J.,
Jurczyszyn Artur
Publication year - 2019
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25579
Subject(s) - multiple myeloma , medicine , multicenter study , retrospective cohort study , oncology , randomized controlled trial
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.