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Real‐world data on incidence, clinical characteristics and outcome of patients with macrofocal multiple myeloma (MFMM) in the era of novel therapies: A study of the Greco‐Israeli collaborative myeloma working group
Author(s) -
Katodritou Eirini,
Kastritis Efstathios,
Gatt Moshe,
Cohen Yael C.,
Avivi Irit,
Pouli Anastasia,
Lalayianni Chrysavgi,
Lavi Noa,
Delimpasis Sosana,
Kyrtsonis MarieChristine,
Michael Michalis,
Suriu Celia,
Miri Zektser,
Tzafarti Katrin,
Vadikoliou Chrysanthi,
Maltezas Dimitris,
Zikos Panagiotis,
Ganzel Chezi,
Vaxman Yuliana,
Aviv Ariel,
Christoforidou Anna,
Gavriatopoulou Maria,
Shaulov Adir,
Verrou Evgenia,
Papanota AristeaMaria,
Fakinos Gabriel,
Gkioka AnnitaIoanna,
Palaska Vasiliki,
Triantafyllou Theodora,
Konstantinidou Pavlina,
Anagnostopoulos Achilles,
Terpos Evangelos,
Dimopoulos Meletios A.
Publication year - 2020
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.25755
Subject(s) - multiple myeloma , medicine , gastroenterology , incidence (geometry) , thalidomide , bone marrow , adverse effect , surgery , anemia , hematology , lactate dehydrogenase , lenalidomide , oncology , physics , optics , biochemistry , chemistry , enzyme
We investigated incidence, characteristics and outcome of patients with macrofocal multiple myeloma (MFMM) treated mainly with novel therapies. Based on definition (BMPCs <20% and lytic lesions/plasmacytomas, without anemia, renal insufficiency or hypercalcemia) we identified 140 patients with MFMM, among 4650 myeloma patients (3%). Twice the number of patients with typical myeloma were used as controls; 60% were <65 years and 70% had advanced bone disease. Plasmacytomas were more frequent in MFMM compared with standard myeloma (68% vs 15%, P < .05). Adverse prognostic parameters (high lactate dehydrogenase, advanced stage, high risk cytogenetics, immunoparesis) were less common in patients with MFMM compared with controls ( P < .05); 90% received novel agents and 47% underwent autologous transplantation upfront; 90% achieved an objective response; 70% had at least very good partial response which was significantly higher compared with controls ( P < .05). After a median follow‐up of 52 months, 33 patients have died. Early death (<12 months) was infrequent in MFMM. Median progression‐free survival and overall survival (OS) were 46 and 129 months respectively, both significantly longer compared with controls ( P < .001). Proteasome inhibitor (PI)‐based therapy was the only independent predictor for OS in the multivariate analysis (HR: 3.9; P < .001). In conclusion, MFMM is a distinct entity presented in young and elderly subjects, characterized by limited bone marrow infiltration, advanced bone disease and frequent presence of plasmacytomas; MFMM patients have less often adverse prognostic features and achieve excellent responses and prolonged OS especially when treated with PI‐based therapies. Novel imaging will help in a more accurate classification of this entity.