Outcome of paraosseous extra-medullary disease in newly diagnosed multiple myeloma patients treated with new drugs

Montefusco, Vittorio; Spada, Stefano; Paoli, Lorenzo De; Raimondo, Francesco Di; Ribolla, Rossella; Musolino, Caterina; Musto, Pellegrino; Galieni, Pietro; Ballanti, Stelvio; Nozzoli, Chiara; Cascavilla, Nicola; Ben‐Yehuda, Dina; Nagler, Arnon; Offidani, Massimo; Liberati, Anna Marina; Sonneveld, Pieter; Cavo, Michèle; Corradini, Paolo; Boccadoro, Mario

doi:10.3324/haematol.2019.219139

Cited by 41 publications

(45 citation statements)

References 34 publications

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“…The use of whole-body imaging techniques to evaluate the presence of MM cells is of uttermost importance, since MM is characterized by a potential patchy infiltration of the bone marrow by plasma cells as well as by the presence of extramedullary disease [42]. Furthermore, clonal heterogeneity may characterize MM, with the coexistence, in the same patient, of multiple clones with different molecular and biological features [27,43].…”

Section: Mrd Outside the Bone Marrowmentioning

confidence: 99%

Minimal Residual Disease in Multiple Myeloma: State of the Art and Future Perspectives

Mina

Oliva

Boccadoro

2020

JCM

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Minimal residual disease (MRD) detection represents a sensitive tool to appropriately measure the response obtained with therapies for multiple myeloma (MM). The achievement of MRD negativity has superseded the conventional complete response (CR) and has been proposed as a surrogate endpoint for progression-free survival and overall survival. Several techniques are available for the detection of MRD inside (next-generation sequencing, flow cytometry) and outside (PET/CT, magnetic resonance) the bone marrow, and their complementary use allows a precise definition of the efficacy of anti-myeloma treatments. This review summarizes MRD data and results from previous clinical trials, highlights open issues related to the role of MRD in MM and discusses how MRD could be implemented in clinical practice to inform on patient prognosis and drive therapeutic decisions.

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Section: Mrd Outside the Bone Marrowmentioning

confidence: 99%

Minimal Residual Disease in Multiple Myeloma: State of the Art and Future Perspectives

Mina

Oliva

Boccadoro

2020

JCM

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“…In contrast, in a Programa Español para el tratamiento de las Hemopatías Malignas (PETHEMA) transplantation trial there were no significant differences in PFS between patients with or without PS involvement; however, the OS was significantly shorter in those with plasmacytomas 61 . Finally, in a meta‐analysis of eight recent Italian trials using new drugs the detrimental effect of EMD disease at diagnosis was limited 75 . Of note, in all the four above mentioned studies, the vast majority of patients had PS involvement and very few had EMD disease.…”

Section: Prognosismentioning

confidence: 90%

“…Unfortunately, there is a lack of prospective clinical trials on patients with MM presenting with plasmacytomas. Recently, the Gruppo Italiano Malattie EMatologiche dell’Adulto (GIMEMA) group published the outcome of 267 patients with soft‐tissue involvement (243 PS) included in eight prospective trials, using bortezomib, lenalidomide or carfilzomib compared with 2065 patients without plasmacytomas 75 . The median PFS was similar in both groups (25·3 vs. 25·2 months), while the median OS was significantly shorter in patients with soft‐tissue involvement (63·5 vs. 79·9 months).…”

Section: Treatment Approachmentioning

confidence: 99%

Expert review on soft‐tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations

et al. 2021

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In this review, two types of soft-tissue involvement in multiple myeloma are defined: (i) extramedullary (EMD) with haematogenous spread involving only soft tissues and (ii) paraskeletal (PS) with tumour masses arising from skeletal lesions. The incidence of EMD and PS plasmacytomas at diagnosis ranges from 1Á7% to 4Á5% and 7% to 34Á4% respectively. EMD disease is often associated with high-risk cytogenetics, resistance to therapy and worse prognosis than in PS involvement. In patients with PS involvement a proteasome inhibitor-based regimen may be the best option followed by autologous stem cell transplantation (ASCT) in transplant eligible patients. In patients with EMD disease who are not eligible for ASCT, a proteasome inhibitor-based regimen such as lenalidomide-bortezomib-dexamethasone (RVD) may be the best option, while for those eligible for high-dose therapy a myeloma/lymphoma-like regimen such as bortezomib, thalidomide and dexamethasone (VTD)-RVD/cisplatin, doxorubicin, cyclophosphamide and etoposide (PACE) followed by SCT should be considered. In both EMD and PS disease at relapse many strategies have been tried, but this remains a high-unmet need population.

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“…The incidence of EMB is 6-35%, and the incidence of EME is 0.5-3.5%. Currently, there is not a precise definition of EMD and a lot of controversies (2,3); also, periods, inspection methods, and the detection rates of each report were different (2,(4)(5)(6)(7). In addition, there were limited data on the baseline characteristics of EMM, such as prevalence, clinical and laboratory characteristics, and the efficacy of new drugs.…”

Section: Introductionmentioning

confidence: 99%

Multiple Extramedullary-Bone Related and/or Extramedullary Extraosseous Are Independent Poor Prognostic Factors in Patients With Newly Diagnosed Multiple Myeloma

Yue

et al. 2021

Front. Oncol.

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BackgroundExtramedullary (EM) lesions are common in multiple myeloma (MM) and are often related to the poor prognosis of MM but are scarcely understood.MethodsIn this retrospective study, the baseline characteristics of 357 newly diagnosed patients with extramedullary multiple myeloma (EMM) and their impact on the prognosis were analyzed. All patients received first-line treatment with bortezomib-based regimen.ResultsThe overall incidence rate of EM was 22.4%, and the detection rate of PET/CT was significantly higher than other imaging methods (P = 0.015). The cohorts consisted of 10 cases of extramedullary extraosseous (EME) and 70 cases of extramedullary-bone related (EMB), including 53 cases with single site involvement (one case with EME) and 27 cases with multiple sites (>1 site) involvement (nine cases with EME). EMM patients had high levels of hemoglobin (Hgb, ≥10 g/dl) and serum lactate dehydrogenase (LDH, >245u/L) and are inclined to early-stage revised international staging system (R-ISS). Compared to patients without EM, those with EMM had worse progression-free survival (PFS) (P = 0.014) and overall survival (OS) (P = 0.032). In addition, patients without EM and those with a single site of EMB had similar PFS and OS, while patients with multiple sites of EMB or EME and multiple sites of EMB with EME had poor PFS and OS. Multivariate analysis confirmed that multiple sites of EMB and/or EME were independent prognostic predictors affecting PFS and OS in newly diagnosed MM patients.ConclusionsThis study suggested that among patients treated with bortezomib-based regimens, multiple sites of EMB and/or EME are independent poor prognostic factors for newly diagnosed MM patients, while a single site of EMB does not affect the survival of newly diagnosed MM patients. Thus, these findings could be used as a reference for the study of EMM patients in the new drug era, but prospective clinical studies are needed to provide evidence-based data for the diagnosis and treatment of EMM.

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Outcome of paraosseous extra-medullary disease in newly diagnosed multiple myeloma patients treated with new drugs

Cited by 41 publications

References 34 publications

Minimal Residual Disease in Multiple Myeloma: State of the Art and Future Perspectives

Minimal Residual Disease in Multiple Myeloma: State of the Art and Future Perspectives

Expert review on soft‐tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations

Multiple Extramedullary-Bone Related and/or Extramedullary Extraosseous Are Independent Poor Prognostic Factors in Patients With Newly Diagnosed Multiple Myeloma

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