Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: A longitudinal study on 1003 consecutive patients

M. Varettoni, A. Corso, G. Pica, S. Mangiacavalli, C. Pascutto, M. Lazzarino

Research output: Contribution to journalArticle

Abstract

Background: There are few data on the incidence and prognosis of extramedullary (EM) multiple myeloma (MM). There are concerns about a possible increase of EM relapses with the expanding use of high-dose therapy (HDT) and biological agents. Patients and methods: The incidence of EM disease, its relationship with prior exposure to HDT or novel agents, and its prognostic impact were analyzed in 1003 MM patients. Based on the different therapies available, three periods were considered: 1971-1993, conventional-dose chemotherapy; 1994-1999, HDT for younger patients; and 2000-2007, introduction of novel agents. Results: Overall, 13% of patients had EM disease, 7% at diagnosis and 6% later. In the 2000-2007 period, there was a significant increase of EM involvement, at diagnosis (P = 0.02) and during follow-up (P = 0.03). The risk of EM spread was not significantly increased after HDT [hazard ratio (HR 0.6)], bortezomib (HR 1.62), or thalidomide/ lenalidomide (HR 1.07). EM disease was associated with shorter overall (HR 3.26, P <0.0001) and progression-free (HR 1.46, P = 0.04) survival. Conclusions: The incidence of EM disease has increased, probably due to the availability of more sensitive imaging techniques and the prolongation of patients' survival. HDT or novel agents seem not to increase the risk of EM disease. EM involvement confers a poor prognosis.

Original languageEnglish
Pages (from-to)325-330
Number of pages6
JournalAnnals of Oncology
Volume21
Issue number2
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Extramedullary
  • High-dose therapy
  • Multiple myeloma
  • Novel agents

ASJC Scopus subject areas

  • Medicine(all)
  • Hematology
  • Oncology

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