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

V. Montefusco, F. Gay, S. Spada, L. De Paoli, F. Di Raimondo, R. Ribolla, C. Musolino, F. Patriarca, P. Musto, P. Galieni, S. Ballanti, C. Nozzoli, N. Cascavilla, D. Ben-Yehuda, A. Nagler, R. Hajek, M. Offidani, AM. Liberati, P. Sonneveld, M....

. 2020 ; 105 (1) : 193-200. [pub] 20190620

Jazyk angličtina Země Itálie

Typ dokumentu časopisecké články, metaanalýza

Perzistentní odkaz   https://www.medvik.cz/link/bmc21020813

Extramedullary disease is relatively frequent in multiple myeloma, but our knowledge on the subject is limited and mainly relies on small case series or single center experiences. Little is known regarding the role of new drugs in this setting. We performed a meta-analysis of eight trials focused on the description of extramedullary disease characteristics, clinical outcome, and response to new drugs. A total of 2,332 newly diagnosed myeloma patients have been included; 267 (11.4%) had extramedullary disease, defined as paraosseous in 243 (10.4%), extramedullary plasmocytoma in 12 (0.5%), and not classified in 12 (0.5%) patients. Median progression-free survival was 25.3 months and 25.2 in extramedullary disease and non-extramedullary disease patients, respectively. In multivariate analysis the presence of extramedullary disease did not impact on progression-free survival (hazard ratio 1.15, P=0.06), while other known prognostic factors retained their significance. Patients treated with immunomodulatory drugs, mainly lenalidomide, or proteasome inhibitors had similar progression-free survival and progression-free survival-2 regardless of extramedullary disease presence. Median overall survival was 63.5 months and 79.9 months (P=0.01) in extramedullary and non-extramedullary disease patients, respectively, and in multivariate analysis the presence of extramedullary disease was associated with a reduced overall survival (hazard ratio 1.41, P<0.001), in line with other prognostic factors. With the limits of the use of low sensitivity imaging techniques, that lead to an underestimation of extramedullary disease, we conclude that in patients treated with new drugs the detrimental effect of extramedullary disease at diagnosis is limited, that lenalidomide is effective as are proteasome inhibitors, and that these patients tend to acquire a more aggressive disease in later stages. (EUDRACT2005-004714-32, NCT01063179 NCT00551928, NCT01091831, NCT01093196, NCT01190787, NCT01346787, NCT01857115).

A O S Maria di Terni S C Oncoematologia Terni Italy

Cellular therapies and Transfusion Medicine Unit Careggi University Hospital Firenze Italy

DAME Udine University Udine Italy

Department of Haematooncology University Hospital Ostrava Ostrava Czech Republic and Faculty of Medicine Ostrava University Ostrava Czech Republic

Department of Hematology and Stem Cell Transplant Unit Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Italy

Department of Hematology ASST Spedali Civili di Brescia Brescia Italy

Department of Hematology Erasmus University Medical Center Rotterdam the Netherlands

Division of Haematology University of Messina Messina Italy

Division of Hematology Department of Translational Medicine Amedeo Avogadro University of Eastern Piedmont and Maggiore Hospital Novara Italy

Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori Milano Italy

Division of Hematology Hadassah Ein Kerem Medical Center Jerusalem Israel

Division of Hematology Ospedale Ferrarotto Azienda Policlinico Ospedale Vittorio Emanuele University of Catania Catania Italy

Division of Hematology Ospedali Riuniti Ancona Italy

Hemato Oncology Department University of Milan Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori Milano Italy

Hematology and Stem Cell Transplantation Unit IRCCS CROB Referral Cancer Center of Basilicata Rionero in Vulture Italy

Hematology Division Chaim Sheba Medical Center Tel HaShomer Israel

Institute of Hematology L and A Seràgnoli Department of Experimental Diagnostic and Specialty Medicine University of Bologna S Orsola Malpighi Hospital Bologna Italy

Myeloma Unit Division of Hematology University of Torino Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino Torino Italy

Sezione di Ematologia e Immunologia Clinica Ospedale Santa Maria della Misericordia di Perugia Perugia Italy

U O C Ematologia e Trapianto di Cellule Staminali Emopoietiche Ospedale Mazzoni Ascoli Piceno Italy

Citace poskytuje Crossref.org

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