Outcome of paraosseous extra-medullary disease in newly diagnosed multiple myeloma patients treated with new drugs
Vittorio Montefusco,
Francesca Gay,
Stefano Spada,
Lorenzo De Paoli,
Francesco Di Raimondo,
Rossella Ribolla,
Caterina Musolino,
Francesca Patriarca,
Pellegrino Musto,
Piero Galieni,
Stelvio Ballanti,
Chiara Nozzoli,
Nicola Cascavilla,
Dina Ben-Yehuda,
Arnon Nagler,
Roman Hajek,
Massimo Offidani,
Anna Marina Liberati,
Pieter Sonneveld,
Michele Cavo,
Paolo Corradini,
Mario Boccadoro
Affiliations
Vittorio Montefusco
Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Francesca Gay
Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
Stefano Spada
Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
Lorenzo De Paoli
Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont and Maggiore Hospital, Novara, Italy
Francesco Di Raimondo
Division of Hematology, Ospedale Ferrarotto, Azienda Policlinico-Ospedale Vittorio Emanuele, University of Catania, Catania, Italy
Rossella Ribolla
Department of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
Caterina Musolino
Division of Haematology, University of Messina, Messina, Italy
Francesca Patriarca
DAME, Udine University, Udine, Italy
Pellegrino Musto
Hematology and Stem Cell Transplantation Unit, IRCCS-CROB, Referral Cancer Center of Basilicata, Rionero in Vulture, Italy
Piero Galieni
U.O.C. Ematologia e Trapianto di Cellule Staminali Emopoietiche, Ospedale Mazzoni, Ascoli Piceno, Italy
Stelvio Ballanti
Sezione di Ematologia e Immunologia Clinica, Ospedale Santa Maria della Misericordia di Perugia, Perugia, Italy
Chiara Nozzoli
Cellular therapies and Transfusion Medicine Unit, Careggi University Hospital, Firenze, Italy
Nicola Cascavilla
Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
Dina Ben-Yehuda
Division of Hematology, Hadassah Ein-Kerem Medical Center, Jerusalem, Israel
Arnon Nagler
Hematology Division, Chaim Sheba Medical Center, Tel-HaShomer, Israel
Roman Hajek
Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic and Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
Massimo Offidani
Division of Hematology, Ospedali Riuniti, Ancona, Italy
Anna Marina Liberati
A O S Maria di Terni, S C Oncoematologia, Terni, Italy
Pieter Sonneveld
Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
Michele Cavo
Institute of Hematology “L. and A. Seràgnoli”, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, “S. Orsola-Malpighi” Hospital, Bologna, Italy
Paolo Corradini
Hemato-Oncology Department, University of Milan, Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
Mario Boccadoro
Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
Extramedullary disease is relatively frequent in multiple myeloma, but our knowledge on the subject is limited and mainly relies on small case series or single center experiences. Little is known regarding the role of new drugs in this setting. We performed a meta-analysis of eight trials focused on the description of extramedullary disease characteristics, clinical outcome, and response to new drugs. A total of 2,332 newly diagnosed myeloma patients have been included; 267 (11.4%) had extramedullary disease, defined as paraosseous in 243 (10.4%), extramedullary plasmocytoma in 12 (0.5%), and not classified in 12 (0.5%) patients. Median progression-free survival was 25.3 months and 25.2 in extramedullary disease and non-extramedullary disease patients, respectively. In multivariate analysis the presence of extramedullary disease did not impact on progression-free survival (hazard ratio 1.15, P=0.06), while other known prognostic factors retained their significance. Patients treated with immunomodulatory drugs, mainly lenalidomide, or proteasome inhibitors had similar progression-free survival and progression-free survival-2 regardless of extramedullary disease presence. Median overall survival was 63.5 months and 79.9 months (P=0.01) in extramedullary and non-extramedullary disease patients, respectively, and in multivariate analysis the presence of extramedullary disease was associated with a reduced overall survival (hazard ratio 1.41, P
