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, Diderik Jan Eikema, Simona Iacobelli, Linda Koster, Hareth Nahi, Anne Marie Stoppa, Tamás Masszi, Denis Caillot, Stig Lenhoff, Miklos Udvardy, Charles Crawley, William Arcese, Clara Mariette, Ann Hunter, Xavier Leleu, Martin Schipperus, Michel Delforge, Pietro Pioltelli, John A. Snowden, Maija Itälä-RemesMaurizio Musso, Anja van Biezen, Laurent Garderet, Nicolaus Kröger

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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 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).

Original languageEnglish
Pages (from-to)890-897
Number of pages8
JournalHaematologica
Volume103
Issue number5
DOIs
Publication statusPublished - Apr 30 2018

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ASJC Scopus subject areas

  • Hematology

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Gagelmann, N., Eikema, D. J., Iacobelli, S., Koster, L., Nahi, H., Stoppa, A. M., Masszi, T., Caillot, D., Lenhoff, S., Udvardy, M., Crawley, C., Arcese, W., Mariette, C., Hunter, A., Leleu, X., Schipperus, M., Delforge, M., Pioltelli, P., Snowden, J. A., ... Kröger, N. (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), 890-897. https://doi.org/10.3324/haematol.2017.178434