Open AccessThe impact of bone marrow fibrosis and JAK2 expression on clinical outcomes in patients with newly diagnosed multiple myeloma treated with immunomodulatory agents and/or proteasome inhibitors
Author(s) -
Paul Barry,
Zhao Yue,
Loitsch Gavin,
Feinberg Daniel,
Mathews Parker,
Barak Ian,
Dupuis Megan,
Li Zhiguo,
Rein Lindsay,
Wang Endi,
Kang Yubin
Publication year - 2020
Publication title -
cancer medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 53
ISSN - 2045-7634
DOI - 10.1002/cam4.3265
Subject(s) - medicine , multiple myeloma , bone marrow , immunohistochemistry , stage (stratigraphy) , oncology , gastroenterology , surgery , paleontology , biology
We determined the impact of bone marrow fibrosis (BMF) on the clinical outcomes of newly diagnosed multiple myeloma (NDMM) patients in the current era of myeloma therapy. A total of 393 MM patients were included in the final analysis. The median followup was 83 months (range: 3.9 to 212 months). BMF was noted in 122 (48.2%) evaluable patients. Median progression free survival (PFS) in patients without BMF was 30.2 (95% CI: 24.7‐38.0) months, and 21.1 (95% CI: 18.8‐27.5) months in patients with BMF present ( P = .024). Median overall survival (OS) was 61.2 (95% CI: 51.5‐81.2) months in patients without BMF, and 45.1 (95% CI: 38.7‐57.0) months in patients with BMF ( P = .0048). A subset of 99 patients had their bone marrow biopsies stained for JAK1 and JAK2 by immunohistochemistry. Of these samples 67 (67.7%) patients had detectable JAK2 expression predominantly noted on bone marrow megakaryocytes. JAK2 expression correlated with myeloma disease stage ( P = .0071). Our study represents the largest dataset to date examining the association of BMF with prognosis in the era of novel therapies and widespread use of hematopoietic stem cell transplant (HSCT). Our data suggest that MM patients with BMF (particularly those with extensive BMF) have a poorer prognosis even when treated with immunomodulatory agents and proteasome inhibitors.