Clinical Analysis Of Extramedullary Mutiple Myeloma

ObjectiveTwo types of extramedullary disease (EMD) can be described:a) tumor mass adjacent to bone (EMD-B), b) plasmacytoma that is not connected to the bone (EMD-S). To analyse the difference among EMD-B, EMD-S and MM patients without EMD(EMD-N) in clinical features and prognosis. And to investigate the clinical difference between primary EMD (EMD-1) and secondary EMD (EMD-2).MethodsThe records of 85 MM patients with EMD and 40 random MM patients without EMD ever treated in our center were retrospectively reviewed.Results(1)Among 85 patients with EMD,60 cases showed EMD at diagonsis, including 38 cases with EMD-B and 22 cases with EMD-S.25 cases developed EMD at the time of disease progression, including 11 cases with EMD-B and 14 cases with EMD-S.(2)Patients with EMD-S at diagonsis showed significant younger age compared with patients without EMD (P=0.022), and higher level of LDH compared with EMD-B, EMD-N patients(P=0.025,<0.001). While the above two parameters were comparable between patients with EMD-B and without EMD.(3)The overall response rate of patients with EMD-S was 64%, which was significant lower compared with EMD-N patients(p=0.019).(4)The overall survival(OS) of patients with EMD-B, EMD-S and without EMD was 31, 22, and 42months, respectively. The Progression Free Survival (PFS)of the three groups was 17,11, and 19 months, respectively. Compared to the patients with EMD-S, the PFS of the other two groups was significantly longer(P=0.016,0.002), and OS of was significant longer in EMD-N(p=0.029).(5)The OS of patients with EMD-B, EMD-S at progression and without EMD was 39, 28, and 42 months, respectively. The PFS of the three groups was 21,11, and 19 months, respectively. The PFS of patients with EMD-S at progression showed significant shorter as compared with the other two groups(P=0.016,0.002).While the OS was comparable among the three groups.(6)Patients with EMD regardless of it is primary or secondary EMD, showed significant younger age and higher level of LDH compared with patients without EMD(P<0.05).Patients with EMD-1 showed higher level of hemoglobin, albumin and lower level of globulin compared with EMD-2 pantients(P<0.05).(7)The ORR of patients with EMD-1, EMD-2 and without EMD was 70%,88%,90%, respectively. The outcome showed no significant difference among the three group.(8)The OS of patients with EMD-B at diagnosis, EMD-B at progression and without EMD was 31,39, and 42 months, respectively. The PFS of the three groups was 17,21, and 19 months, respectively. The outcome(both PFS and OS) showed no significant difference among the three group.The OS of patients with EMD-s at diagnosis, EMD-S at progression and without EMD was 22,28, and 42 months, respectively. The PFS of the three groups was 11,11, and 19 months, respectively. The OS of patients with EMD-S at diagnosis showed significant shorter as compared with the patients without EMD(p=0.029).The PFS of patients with EMD-S regardless of it is primary or secondary EMD showed significant shorter as compared with the patients without EMD(p=0.002,0.005).Conclusions:The presence of EMD-S was a very strong negative prognostic factor. The clinical features of MM patients with EMD-B are similar with the patients without EMD. However, survival analysis showed EMD-B may affect the prognosis.