In multiple myeloma (MM), malignant plasma cells infiltrate the bone marrow. In some cases, plasma cells migrate out of the bone marrow creating either para-skeletal plasmacytomas (PS) or infiltrating soft tissues as extramedullary plasmacytomas (EMD). The aim of this study was to define risk groups in newly diagnosed MM (NDMM) patients with PS and EMD plasmacytomas. In total, 523 NDMM patients with PS plasmacytomas and 196 NDMM patients with EMD plasmacytomas were diagnosed in the Czech Republic between 2004 and 2021 using modern imaging methods. Patients’ data were analyzed from the Registry of Monoclonal Gammopathies of the Czech Myeloma Group. In NDMM patients with PS plasmacytomas, we found a subgroup with <5% of bone-marrow plasma cells to have the best prognosis (mPFS: 58.3 months (95% CI: 33.0−NA); mOS: not reached). The subgroup with >5% of bone-marrow plasma cells and ≥3 plasmacytomas had the worst prognosis (mPFS: 19.3 months (95% CI: 13.4−28.8), p < 0.001; mOS: 27.9 months (95% CI: 19.3−67.8), p < 0.001). Our results show association between tumor burden and prognosis of NDMM patients with plasmacytomas. In the case of PS plasmacytomas, NDMM patients with low BM PC infiltration have an excellent prognosis.

1st Medical Department Clinical Department of Hematology of the 1st Faculty of Medicine and General Teaching Hospital Charles University 128 08 Prague Czech Republic

4th Department of Medicine Hematology Charles University Hospital and Faculty of Medicine 500 05 Hradec Kralove Czech Republic

Babak Myeloma Group Department of Pathophysiology Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Department of Hemato Oncology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc 779 00 Olomouc Czech Republic

Department of Hematooncology University Hospital Ostrava and Faculty of Medicine University of Ostrava 708 00 Ostrava Czech Republic

Department of Internal Medicine and Hematology University Hospital Kralovske Vinohrady 100 34 Prague Czech Republic

Department of Internal Medicine Hematology and Oncology University Hospital Brno and Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

Hematology and Oncology Department Charles University Hospital 323 00 Pilsen Czech Republic

Institute of Biostatistics and Analyses Ltd 625 00 Brno Czech Republic

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Liquid biopsy of peripheral blood using mass spectrometry detects primary extramedullary disease in multiple myeloma patients

Daratumumab with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma patients - real world evidence analysis