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Am J Hematol ; 94(10): 1132-1140, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31334859

RESUMO

The current study assesses the characteristics and outcomes of multiple myeloma (MM) patients, treated with novel agents for hematogenous extramedullary (HEMM) relapse. Consecutive patients diagnosed with HEMM between 2010-2018 were included. Patients' characteristics at diagnosis and at HEMM presentation, response to treatment, survival and factors predicting survival were recorded and analyzed. A group of 127 patients, all diagnosed with HEMM by imaging (87.3%) and/or biopsy (79%), were included. Of those, 44% were initially diagnosed with ISS3, 57% presented with plasmacytomas, and 30% had high-risk cytogenetics. Median time to HEMM was 32 months. In multivariate analysis, ISS3 and bone plasmacytoma predicted shorter time to HEMM (P = .005 and P = .008, respectively). Upfront autograft was associated with longer time to HEMM (P = .002). At HEMM, 32% of patients had no BM plasmacytosis, 20% had non-secretory disease and 43% had light-chain disease. Multiple HEMM sites were reported in 52% of patients, mostly involving soft tissue, skin (29%), and pleura/lung (25%). First treatment for HEMM included proteasome inhibitors (50%), immunomodulatory drugs (IMiDs) (39%), monoclonal antibodies (10%), and chemotherapy (53%). Overall response rate (ORR) was 57%. IMiDs were associated with higher ORR (HR 2.2, 95% CI 1.02-4.7, P = .04). Median survival from HEMM was 6 months (CI 95% 4.8-7.2). Failure to achieve ≥VGPR was the only significant factor for worse OS in multivariate analyses (HR = 9.87, CI 95% 2.35 - 39, P = .001). In conclusion, HEMM occurs within 3 years of initial myeloma diagnosis and is associated with dismal outcome. The IMiDs might provide a higher response rate, and achievement of ≥VGPR predicts longer survival.


Assuntos
Neoplasias Ósseas/patologia , Pulmão/patologia , Mieloma Múltiplo/patologia , Células Neoplásicas Circulantes , Plasmocitoma/patologia , Pleura/patologia , Terapia de Salvação/métodos , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoenxertos , Neoplasias Ósseas/sangue , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/terapia , Sistema Nervoso Central/patologia , Terapia Combinada , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Fatores Imunológicos/administração & dosagem , Estimativa de Kaplan-Meier , Fígado/patologia , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/terapia , Células-Tronco Neoplásicas/patologia , Especificidade de Órgãos , Plasmócitos/patologia , Plasmocitoma/sangue , Plasmocitoma/tratamento farmacológico , Plasmocitoma/terapia , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Inibidores de Proteassoma/administração & dosagem , Recidiva , Estudos Retrospectivos
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