Analysis of High-Risk Extramedullary Relapse Factors in Newly Diagnosed MM Patients

Abstract

Extramedullary relapse of multiple myeloma (MM) is often resistant to existing treatments, and has an extremely poor prognosis, but our understanding of extramedullary relapse is still limited. The incidence, clinical characteristics, impact on the prognosis of extramedullary relapse, and the risk factors for extramedullary relapse in NDMM patients were analyzed. Among the 471 NDMM patients, a total of 267 patients had disease relapse during follow-up, including 64 (24.0%) patients with extramedullary relapse. Extramedullary relapse was more common in patients with younger age, IgD subtype, elevated LDH, extensive osteolytic lesions, extramedullary involvement, and spleen enlargement at the time of MM diagnosis. Survival analysis showed that extramedullary relapse patients had significantly worse median OS than patients with relapse but without extramedullary involvement (30.8 months vs. 53.6 months, p = 0.012). Multivariate analysis confirmed that elevated LDH (OR = 2.09, p = 0.023), >2 osteolytic lesions (OR = 3.70, p < 0.001), extramedullary involvement (OR = 3.48, p < 0.001) and spleen enlargement (OR = 2.27, p = 0.011) at the time of MM diagnosis were independent risk factors for extramedullary relapse in NDMM patients. Each of the above four factors was assigned a value of 1 to form the extramedullary relapse prediction score, and the 3-year extramedullary relapse rates of patients in the 0–2 and 3–4 score groups were 9.0 % and 76.7 %, respectively. This study suggested that extramedullary relapse was associated with poor clinical characteristics and poor prognosis in NDMM patients. The extramedullary relapse prediction score model composed of LDH, osteolytic lesions, extramedullary involvement and spleen enlargement has a better ability to predict extramedullary relapse than the existing ISS and R-ISS stages.

Proteomic Alteration in the Progression of Multiple Myeloma: A Comprehensive Review

“…The aggressive stage of MM is characterized by extramedullary MM (EMM), which was reported in roughly 7% of NDMM and increased to 30% of patients with relapse [165]. After a series of molecular alterations, the clonal cells of the MM disease were able to escape from the bone marrow and migrate via the circulatory system to access and grow independently in other organs and tissues [166].…”

Multiple myeloma extramedullary relapse at the sellar and suprasellar region after autologous stem cell transplantation

“…showed that among newly diagnosed MM patients where ASCT was used, 57% had disease relapse during follow-up, including 24% of patients with EM relapse. [ 33 ] EM relapse of MM is often resistant to existing treatments and has an extremely poor prognosis. [ 8 , 33 ] Survival analysis showed that EM relapse patients had significantly worse median overall survival than patients with relapse but without EM involvement.…”

“…[ 33 ] EM relapse of MM is often resistant to existing treatments and has an extremely poor prognosis. [ 8 , 33 ] Survival analysis showed that EM relapse patients had significantly worse median overall survival than patients with relapse but without EM involvement. [ 33 ] Plasmacytoma occurrence at relapse in patients with upfront ASCT is significantly associated with a poor prognosis.…”