Page 213 - 2020_01-Haematologica-web

Improving outcome in MM with EMD
5.7 months; P=NS). Since Jurczyszyn et al.20 have demon- strated a survival advantage among younger patients, an age cut-off of 45 years was adopted (Table 1) revealing younger age for PO (59 years) versus EMP (64 years) (P=0.01). Median ages of patients presenting with PO (58.5 years) or EMP (62 years) at diagnosis were not signif- icantly different. The imaging modalities used for the diagnosis were CT (n=133), PET-CT (n=50) and MRI
Table 1. Baseline characteristics of patients. Characteristics (n=226)
Age, years, Median (range)
Age, years, Median (range) Age ≤45 vs. >45 (at diagnosis) Age ≤45 vs. >45 (at relapse)
ISS stage (at myeloma diagnosis) Stage I, n (%)
Stage II, n (%)
Stage III, n (%)
Unknown
Number of FISH abnormalities
No abnormalities, n (%) 1 abnormality, n (%)
2 abnormalities, n (%) ≥3 abnormalities, n (%) Del17p, n (%)
Del13q, n (%) t (4;14), n (%) t (14;16), n (%) t (11;14), n (%)
Anatomical locations of EMP Soft tissue (muscle/skin) n (%) Lymph nodes, n (%)
Pleural, n (%)
Liver, n (%)
Central nervous system, n (%) Abdominal, n (%)
Oropharynx, n (%)
Lung, n (%)
Testis, n (%)
Others, n (%)
Initial therapy for EMD (all patients)
Only radiotherapy, n (%)
Systemic chemotherapy (without novel agent) Thalidomide combinations*, n (%)
PI combinations*, n (%)
Len/Pom combinations*, n (%)
PI+IMID combinations:
VDT, n(%)
VRD, n(%)
Monoclonal antibodies, n(%)
Lines of therapy after EMD diagnosis
1-2 lines, n (%)
>2 lines, n (%)
Autologous stem cell transplantation, n (%)
(n=35). The anatomical distribution of EMD is depicted in Table 1. Most patients with EMP (65%) presented with one involved site, 16% had two sites, and 11% had three sites, while involvement in four and five sites was present in 7% of patients, respectively.
Cytogenetic analysis of clonal plasma cells in the bone marrow at the time of MM diagnosis was available for 111 of 226 (49.1%) of the patients with EMD (Table 1).
Results
62 (34-87)
EMP: 64 (34-87) PO: 59 (36-83) P=0.01 EMP: 13 vs. 79 PO:2 vs. 36
EMP:
3 vs. 81 PO:1 vs. 11
76 (33.6 %) 68 (30.1 %) 76 (33.6 %) 6 (2.7%)
57 (51.3 %) 28 (25.2 %) 12 (10.8 %) 12 (10.8 %) 10 (9 %) 20 (18 %) 8 (7.2 %)
2 (1.8 %)
4 (3.6 %)
55 (24.3 %) 23 (10.2 %) 27 (11.9 %) 21 (9.3 %) 14 (6.2 %) 9 (4.0 %)
8 (3.5 %) 7 (3.1 %) 4 (1.8 %) 4 (1.8 %)
At initial diagnosis
9 (6.9 %)
34 (26.2%) 13 (10%) 63 (48.5%) 5 (3.8%) -
6 (4.6%) -
121 (53.8 %) 104 (46.2 %) 100 (44.2 %)
At relapse
-
23 (24%)
2 (2.1%) 40 (41.7%) 8 (8.3%) 4 (4.2%) 12 (12.5%) 7 (7.3%)
*Thalidomide combinations: thalidomide-dexamethasone/TAD/other thalidomide combinations; PI combinations: Vel-Dex/VCD/VMP/other bortezomib combinations or Carfilzomib-Dex; Len/Pom combinations: Len-dex/RCD/Pomalidomide-Dex or other Lenalidomide combinations.TAD: thalidomide-adriamycin-dexamethasone;Vel: bortezomib; dex: dexamethasone; VCD: bortezomib/cyclophosphamide/dexamethasone; VMP: bortezomib/melphalan/prednisolone; Len: lenalidomide; RCD: lenalidomide/cyclophos- phamide/dexamethasone;VDT:bortezomib/dexamethasone/thalidomide;VRD:bortezomib/lenalidomide/dexamethasone.
haematologica | 2020; 105(1)
203