Abstract
Background:Extramedullary myeloma (EMM) is the synchronous presence of clonal plasma cells (CPC) at bone marrow and distant sites. Its frequency is reported among 6‐20% of multiple myeloma (MM) patients and manifest as bone‐dependent plasmocitoma (BP) or tissue‐dependent plasmocitoma (TP). Previous reports state a more aggressive clinical course, whether at diagnosis or relapse. There is no data regarding the clinical course and prognosis in Mexican patients with EMM.Aims:To analyze and describe the impact of EMM on overall survival (OS) and progression free survival (PFS) of Mexican patients diagnosed and treated at monoclonal gammapathies clinic of our institution.MethodsRetrospective analysis including >18 year‐old patients with MM diagnosis according to IMWG criteria. EMM was defined as presence of CPC corroborated by immunohistochemistry in BP or TP or demonstration of a synchronous tumor by imaging method and no accessible to biopsy.Results:A total of 199 patients were included. Sixty‐three patients had EMM (31.8%), 45 cases (71.4%) presented at diagnosis and 18 (28.6%) at progression. Forty‐eight cases (76.2%) were diagnosed by biopsy and 15 (23.8%) by imaging. Fifty‐four percent (n = 34) cases presented BP and 46% (n = 29) TP. Most frequently involved sites were abdomen (34.5%), thorax (27.6%) and lymph nodes (13.8%) in TP and spine (50%), chest wall (26.3%) and head/neck (13.2%) in BP. EMM was associated with lower comorbidity rate and higher renal failure. Population characteristics are shown in Table 1. Mean PFS and OS was 22.9 and 43.7 months, respectively. EMM at any time of disease resulted on lower PFS and OS (p = 0.03, p = 0.04), while TP showed lower OS (p < 0.01). A higher ECOG PS and lower deep response was associated with worse PFS (HR 1.05‐2.60 (p = 0.03) and HR 0.20‐0.38 (p < 0.01), respectively) while ISS and lower deep response resulted on worse OS (HR 1.0‐2.2 (p = 0.02) and HR 0.37‐0.73 (p < 0.01)) at multivariate regression.Summary/Conclusion:A higher EMM rate was found in the studied population. EMM was associated to higher renal failure and low incidence of comorbidities, as shorter PFS and OS, particularly in TP. Identification of this high risk myeloma population allows an attempt for more intensive treatment with intention to improve prognosis.image
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