Page 158 - Haematologica-5

Haematologica 2018 Volume 103(5):890-897
8 9 10 11 Stig Lenhoff, Miklos Udvardy, Charles Crawley, William Arcese,
Ferrata Storti Foundation
Plasma Cell Disorders
Impact of extramedullary disease in patients with newly diagnosed multiple myeloma undergoing autologous stem cell transplantation: a study from the Chronic Malignancies Working Party of the EBMT
Nico Gagelmann,1 Diderik-Jan Eikema,2 Simona Iacobelli,3 Linda Koster,2
Hareth Nahi,4 Anne-Marie Stoppa,5 Tamás Masszi,6 Denis Caillot,7
Clara Mariette,12 Ann Hunter,13 Xavier Leleu,14 Martin Schipperus,15
Michel Delforge,16 Pietro Pioltelli,17 John A. Snowden,18 Maija Itälä-Remes,19 Maurizio Musso,20 Anja van Biezen,2 Laurent Garderet21 and Nicolaus Kröger1
1Department of Stem Cell Transplantation, University Medical Center Hamburg- Eppendorf, Hamburg, Germany; 2EBMT Data Office, Leiden, the Netherlands; 3Dipartimento di Biologia, Università degli Study di Roma “Tor Vergata”, Italy; 4Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden; 5Institut Paoli Calmettes, Marseille, France; 6St. István and St. László Hospital, Budapest, Hungary; 7Hématologie Clinique, Dijon University Hospital, Dijon, France; 8Department of Hematology, Skane University Hospital Lund, Sweden; 9Department of Hematology, Bone Marrow Transplant Unit, Debrecen Medical University, Hungary; 10Department of Haematology, Cambridge University Hospitals, UK; 11University Tor Vergata, Roma, Italy; 12Department of Hematology, Grenoble University Hospital, France; 13Leicester Royal Infirmary, Leicester; 14Hematology, Hôpital La Mileterie, Poitiers, France; 15Haga Teaching Hospital, the Hague, the Netherlands; 16Department of Hematology, UZ Leuven, Belgium; 17Hematology, Ospedale San Gerardo ASST Monza- Università degli Studi di Milano Bicocca, Monza, Italy; 18Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; 19Turku University Hospital, Finland; 20Division of Hematology, Casa di Cura "La Maddalena", Palermo, Italy and 21Hopital St Antoine, Paris, France
ABSTRACT
We investigated extramedullary disease in newly diagnosed mul- tiple myeloma patients and its impact on outcome following first-line autologous stem cell transplantation. We identified 3744 adult myeloma patients who received up-front single (n=3391) or tandem transplantation (n=353) between 2005 and 2014 with available data on extramedullary involvement at diagnosis. The overall incidence of extramedullary disease was 18.2% (n=682) and increased per year from 6.5% (2005) to 23.7% (2014). Paraskeletal involvement was found in 543 (14.5%) and extramedullary organ involvement in 139 (3.7%). More patients with extramedullary organ involvement had multiple involved sites (≥2; P<0.001). In a comparison of patients with single sites with patients without the disease, up-front transplantation resulted in at least similar 3-year progression-free survival (paraskeletal: P=0.86, and extramedullary organ: P=0.88). In single paraskeletal involvement, this translated less clearly into worse 3-year overall survival (P=0.07) while single organ involvement was significantly worse (P=0.001). Multiple organ sites were associated with worse outcome (P<0.001 and P=0.01). First-line treatment with tandem compared with single transplantation resulted in similar survival in patients with extramedullary disease at diagnosis (P=0.13 for both).
Introduction
Multiple myeloma (MM) accounts for approximately 2% of all new cancer cases and 13% of hematologic cancers with an age-adjusted incidence of 6 per 100,000 per year in the USA and Europe.1 Autologous stem cell transplantation (ASCT) and the development of new agents have considerably increased the median survival of MM patients.2 The disease is characterized by a clonal proliferation of malignant plasma cells with a strong dependence on the bone marrow (BM) microenviron- ment.3
Correspondence:
nkroeger@uke.uni-hamburg.de
Received: August 15, 2017. Accepted: January 26, 2018. Pre-published: February 1, 2018.
doi:10.3324/haematol.2017.178434
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