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Unexpected Heterogeneity of Newly Diagnosed Multiple Myeloma Patients with Plasmacytomas
Martin Stork1, Sabina Sevcikova2, Tomas Jelinek3
1Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic.
Abstract:
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.
Insights
Newly diagnosed multiple myeloma patients with low bone marrow plasma cell infiltration and parasternal plasmacytomas show the best prognosis. High tumor burden indicates a worse outcome, highlighting the link between tumor load and survival in multiple myeloma.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- Multiple myeloma (MM) involves malignant plasma cells in the bone marrow.
- Plasma cells can migrate, forming parasternal (PS) or extramedullary (EMD) plasmacytomas.
Purpose of the Study:
- To identify risk groups in newly diagnosed multiple myeloma (NDMM) patients with PS and EMD plasmacytomas.
- To correlate tumor burden with prognosis in NDMM patients with plasmacytomas.
Main Methods:
- Analysis of data from 523 NDMM patients with PS and 196 with EMD plasmacytomas diagnosed between 2004-2021.
- Utilized data from the Registry of Monoclonal Gammopathies of the Czech Myeloma Group.
- Employed modern imaging methods for diagnosis.
Main Results:
- NDMM patients with PS plasmacytomas and <5% bone marrow plasma cells had the best prognosis (median PFS: 58.3 months, OS not reached).
- Patients with >5% bone marrow plasma cells and ≥3 PS plasmacytomas had the worst prognosis (median PFS: 19.3 months, OS: 27.9 months).
- A significant association was found between tumor burden and prognosis.
Conclusions:
- Tumor burden is a key factor in the prognosis of NDMM patients with plasmacytomas.
- NDMM patients with PS plasmacytomas and low bone marrow plasma cell infiltration exhibit an excellent prognosis.
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