Efficacy And Prognosis Of Newly Diagnosed Multiple Myeloma With Extramedullary Disease

Objective:To investigate the clinical features,prognosis and influencing factors of newly diagnosed multiple myeloma patients with extramedullary disease,and to analyze the effect of Bortezomib-based treatment on the prognosis of patients.Methods:A total of 108 patients with multiple myeloma who were admitted to the Department of Hematology of Yijishan Hospital of Wannan Medical University on January 1,2014 and December 31,2020 were included in this study.Among them,37patients were initially diagnosed with extramedullary disease（group A）and 71 patients were not（group B）.Clinical and laboratory indicators,ISS stage,D-S stage,type of clone,proportion of bone marrow plasma cells,number of bone destruction≥3,treatment plan and efficacy of patients at first diagnosis were collected.Clinical characteristics and survival benefits of group A and group B were also collected.Thirty-seven patients with EMD were divided into bone-related EMD（b-EMD）and strict EMD（s-EMD）according to different sites of EMD.The survival difference between the two subgroups and the factors affecting the prognosis of EMD patients were analyzed.Progression free survival（PFS）and Overall survival（OS）were analyzed according to whether patients contained Bortezomib in induction treatment.Results:The common M protein types in the newly diagnosed patients with MM with extramedullary disease were IgG type,IgA type and light chain type,respectively.There were 27 patients with b-EMD,and the involved sites were 37%（10/27）of ribs,33.3%（9/27）of vertebral body,7.4%（2/27）of clavicle,femur and frontal bone,3.7%（1/27）of sternal bone,humerus and scapula.The extramedullary involvement sites were60%（6/10）in the spinal canal,20%（2/10）in the liver,10%（1/10）in the abdominal wall and 10%（1/10）in the pancreas.And was not associated with medullary,compared to the pathological changes of MM patients with gender,age,Peripheral blood lymphocyte count（ALC）and mononuclear cell count（AMC）,neutrophil counts and lymphocyte count ratio（NLR）,lymphocyte count and blood mononuclear cell count ratio（LMR）,platelet count and lymphocyte count ratio（PLR）,Lactic dehydrogenase（LDH）,Creatinine（Cr）,β₂-microglobulin（β₂-MG）,C-reactive protein（CRP）,ISS stage,D-S stage,clone type,proportion of bone marrow plasma cells at initial diagnosis,and number of bone destruction≥3 were not statistically significant.The laboratory indicators Hemoglobin（Hb）,Albumin（Alb）and Serum calcium（Ca⁺）were statistically different between the two groups.Cox regression analysis of EMD group showed no independent risk factors affecting PFS and OS.By December 2020,108 patients were followed up,and the median follow-up time was 30 months.The median PFS of group A and group B was 18 months and 26 months,respectively,and the median OS time of the two groups did not reach.The predicted 3-year PFS and 3-year OS of group A and B were 12.6%and 57.9%,respectively,and 59.6%and 92.7%,respectively,with statistically significant differences.In group A,compared with group B,the median PFS time of S-EMD and B-EMD was 13 months,19 months and 26 months,respectively,and the median OS time of the three groups did not reach.The predicted 2-year PFS of the three groups was 0,24.1%and 57.9%,respectively,and the predicted 2-year OS of the three groups was 0%,84.6%and 96.8%,respectively.The differences were significant.The median PFS time of all MM patients initially induced with Bortezomib was 27 months,and the median OS time was not reached.The median PFS of MM patients without Bortezomib was 21 months,and the median OS of MM patients without Bortezomib was 46 months.The predicted 3-year PFS of patients treated with and without Bortezomib were 61.4%and 25%（P<0.05）,respectively,and the predicted3-year OS of MM patients treated with and without Bortezomib was 89%and 62.1%（P<0.05）,respectively.The median PFS of patients treated with and without Bortezomib in group A was 22 months and 18 months,respectively,and the median OS of the two groups did not reach.The predicted 2-year PFS of patients in the two groups were32.8%and 0%（P>0.05）,respectively,and the predicted 2-year OS of patients in the two groups were 84.7%and 83.1%（P BBB>05）,respectively,without statistical significance.The median PFS time of patients treated with Bortezomib and without Bortezomib in group B was 30 months and 24 months,respectively,and the median OS of the two groups did not reach.The predicted 3-year PFS of patients in the two groups were 69.9%and 4.7%（P<0.05）,respectively,and the predicted 3-year OS of patients in the two groups were 97.1%and 84%（P<0.05）,respectively,and the difference was statistically significant.Conclusion:1.The most common type of clone with MM extramedullary disease at initial diagnosis was IgG type,and the most common site of involvement was para-rib soft tissue.2.Compared with MM patients without extramedullary disease,there was no significant correlation between gender,age,clone type and other indicators in the group of MM patients with extramedullary disease at initial diagnosis.Cox analysis showed no independent risk factors affecting PFS and OS in EMD patients.3.Compared with MM patients without extramedullary disease,EMD patients have a poor prognosis,and the prognosis of s-EMD patients is significantly worse than that of b-EMD patients.4.Bortezomib improves survival in patients with newly diagnosed MM without extramedullary disease,but does not overcome poor outcomes in patients with EMD.