Incidence and clinical features of extramedullary multiple myeloma in patients who underwent stem cell transplantation
Open Access
- 1 April 2015
- journal article
- research article
- Published by Wiley in British Journal of Haematology
- Vol. 169 (6), 851-858
- https://doi.org/10.1111/bjh.13383
Abstract
Extramedullary disease (EMD), defined as an infiltrate of clonal plasma cells at an anatomic site distant from the bone marrow, is an uncommon manifestation of multiple myeloma. Six hundred and sixty‐three consecutive patients with multiple myeloma who underwent stem cell transplantation between January 2005 and December 2011 were assessed for the presence of EMD. A cohort of 55 patients with biopsy‐proven EMD was identified, comprising 8·3% of the total study population. EMD was present at the time of diagnosis in 14·5% of cases and at the time of relapse in 76% of patients. The most common EMD presentations at relapse were liver involvement and pleural effusions. EMD specimens had high expression of CD44 (92%) and moderate expression of CXCR4. The median overall survival from time of myeloma diagnosis was 4·1 years (95% CI: 3·1, 5·1) and the median overall survival from time of EMD diagnosis was 1·3 years (95% CI: 0·8, 2·3). This report demonstrates that the incidence of EMD has not increased with the introduction of novel agents and stem cell transplantation. The most common EMD presentations in the relapsed setting were liver and pleural fluid. The presence of CD44 and CXCR4 expression may represent new markers of EMD that warrant further investigation.Keywords
Funding Information
- National Cancer Institute (R01 CA181683-01A1)
This publication has 20 references indexed in Scilit:
- Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agentsHaematologica, 2012
- Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myelomaLeukemia, 2011
- F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myelomaPublished by American Society of Hematology ,2009
- Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patientsAnnals Of Oncology, 2009
- Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple MyelomaNew England Journal of Medicine, 2007
- Extramedullary disease and targeted therapies for hematological malignancies—is the association real?Annals Of Oncology, 2006
- Phase III Clinical Trial of Thalidomide Plus Dexamethasone Compared With Dexamethasone Alone in Newly Diagnosed Multiple Myeloma: A Clinical Trial Coordinated by the Eastern Cooperative Oncology GroupJournal of Clinical Oncology, 2006
- Bortezomib or High-Dose Dexamethasone for Relapsed Multiple MyelomaNew England Journal of Medicine, 2005
- A Prospective, Randomized Trial of Autologous Bone Marrow Transplantation and Chemotherapy in Multiple MyelomaNew England Journal of Medicine, 1996
- Presenting Features and Prognosis in 72 Patients With Multiple Myeloma Who Were Younger Than 40 YearsBritish Journal of Haematology, 1996