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

Gagelmann, Nico and Eikema, Diderik-Jan and Iacobelli, Simona and Koster, Linda and Nahi, Hareth and Stoppa, Anne-Marie and Masszi, Tamás and Caillot, Denis and Lenhoff, Stig and Udvardy, Miklós and Crawley, Charles and Arcese, William and Mariette, Clara and Hunter, Ann and Leleu, Xavier and Schipperus, Martin and Delforge, Michel and Pioltelli, Pietro and Snowden, John A. and Itälä-Remes, Maija and Musso, Maurizio and van Biezen, Anja and Garderet, Laurent and Kröger, Nicolaus (2018) 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. HAEMATOLOGICA, 103 (5). pp. 890-897. ISSN 0390-6078

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Abstract

We investigated extramedullary disease in newly diagnosed multiple myeloma patients and its impact on outcome following first line autologous stem cell transplantation. We identified 3744 adult myeloma patients who received upfront single (n = 3391) or tandem transplantation (n = 353) between 2005 and 2014 with available data on extramedullary in-volvement 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%) while the majority of 3062 (81.8%) patients had no extramedullary disease. More patients with extramedul-lary organ involvement had multiple involved sites (>/=2;) (p < 0.001). In patients with single sites compared to patients without the disease, upfront 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 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, respectively).

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