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Updated: Jun 21, 2026
Interphase Fluorescence in situ Hybridization of Bone Marrow Smears of Multiple Myeloma
Published on: April 15, 2022
Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on
M Varettoni1, A Corso1, G Pica1
1Division of Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy.
Background:
There are few data on the incidence and prognosis of extramedullary (EM) multiple myeloma (MM). There are concerns about a possible increase of EM relapses with the expanding use of high-dose therapy (HDT) and biological agents.
Patients And Methods:
The incidence of EM disease, its relationship with prior exposure to HDT or novel agents, and its prognostic impact were analyzed in 1003 MM patients. Based on the different therapies available, three periods were considered: 1971-1993, conventional-dose chemotherapy; 1994-1999, HDT for younger patients; and 2000-2007, introduction of novel agents.
Results:
Overall, 13% of patients had EM disease, 7% at diagnosis and 6% later. In the 2000-2007 period, there was a significant increase of EM involvement, at diagnosis (P = 0.02) and during follow-up (P = 0.03). The risk of EM spread was not significantly increased after HDT [hazard ratio (HR 0.6)], bortezomib (HR 1.62), or thalidomide/lenalidomide (HR 1.07). EM disease was associated with shorter overall (HR 3.26, P < 0.0001) and progression-free (HR 1.46, P = 0.04) survival.
Conclusions:
The incidence of EM disease has increased, probably due to the availability of more sensitive imaging techniques and the prolongation of patients' survival. HDT or novel agents seem not to increase the risk of EM disease. EM involvement confers a poor prognosis.
Insights
Extramedullary (EM) multiple myeloma (MM) incidence has risen, but high-dose therapy (HDT) and novel agents do not appear to increase EM relapse risk. EM disease significantly worsens patient survival outcomes.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Limited data exists on extramedullary (EM) multiple myeloma (MM) incidence and prognosis.
- Concerns exist regarding potential increases in EM relapses with advanced therapies like high-dose therapy (HDT) and biological agents.
Purpose of the Study:
- To analyze the incidence, risk factors, and prognostic impact of EM disease in multiple myeloma (MM).
- To investigate the relationship between EM involvement and prior exposure to HDT or novel agents.
Main Methods:
- A cohort of 1003 MM patients was analyzed across three treatment eras: 1971-1993 (conventional chemotherapy), 1994-1999 (HDT), and 2000-2007 (novel agents).
- Incidence of EM disease, association with therapies, and survival outcomes were evaluated.
Main Results:
- Overall, 13% of patients had EM disease (7% at diagnosis, 6% later).
- The 2000-2007 period showed a significant increase in EM involvement at diagnosis and during follow-up.
- EM disease was linked to significantly shorter overall survival (HR 3.26) and progression-free survival (HR 1.46).
Conclusions:
- The incidence of EM disease has increased, potentially due to improved imaging and longer patient survival.
- High-dose therapy (HDT) and novel agents (bortezomib, thalidomide/lenalidomide) did not significantly increase the risk of EM spread.
- Extramedullary (EM) involvement in multiple myeloma (MM) is associated with a poor prognosis.
