Neurological Outcomes and the Need for Retreatments Among Multiple Myeloma Patients With High-Grade Spinal Cord...

Area of Science:

• Oncology
• Neurosurgery
• Radiation Oncology

Background:

• Epidural Spinal Cord Compression (ESCC) affects up to 30% of Multiple Myeloma (MM) patients.
• Timely diagnosis and treatment are crucial to prevent irreversible neurological damage in ESCC.
• Optimal treatment strategies for high-grade ESCC in MM remain debated.

Purpose of the Study:

• To compare neurological outcomes and retreatment rates in MM patients with high-grade ESCC.
• To evaluate the efficacy of isolated radiotherapy versus surgical interventions for high-grade ESCC.

Main Methods:

• Retrospective cohort study of 247 MM patients with high-grade ESCC.
• Comparison of pre- and post-treatment American Spinal Injury Association (ASIA) scores between radiotherapy and surgery groups.
• Multivariable logistic regression analysis to assess neurologic compromise, pain, and retreatment rates.

Main Results:

• Surgical treatment resulted in better neurological function (64% ASIA E) compared to radiotherapy (53% ASIA E).
• Patients undergoing surgery had significantly lower odds of neurologic deterioration (OR=.15) and less pain (OR=.29).
• No significant difference in retreatment (OR=.64) or mortality (HR=.62) risk between the groups.

Conclusions:

• Surgical intervention for high-grade ESCC in MM patients leads to superior neurological outcomes compared to radiotherapy.
• Surgery does not increase the risk of retreatment or death in this patient population.
• These findings support surgical management as a preferred option for high-grade ESCC in MM patients.