Real-world data on incidence, clinical characteristics and outcome of patients with macrofocal multiple myeloma (MFMM) in the era of novel therapies: A study of the Greco-Israeli collaborative myeloma working group

Eirini Katodritou*, Efstathios Kastritis, Moshe Gatt, Yael C. Cohen, Irit Avivi, Anastasia Pouli, Chrysavgi Lalayianni, Noa Lavi, Sosana Delimpasis, Marie Christine Kyrtsonis, Michalis Michael, Celia Suriu, Zektser Miri, Katrin Tzafarti, Chrysanthi Vadikoliou, Dimitris Maltezas, Panagiotis Zikos, Chezi Ganzel, Yuliana Vaxman, Ariel AvivAnna Christoforidou, Maria Gavriatopoulou, Adir Shaulov, Evgenia Verrou, Aristea Maria Papanota, Gabriel Fakinos, Annita Ioanna Gkioka, Vasiliki Palaska, Theodora Triantafyllou, Pavlina Konstantinidou, Achilles Anagnostopoulos, Evangelos Terpos, Meletios A. Dimopoulos

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

We investigated incidence, characteristics and outcome of patients with macrofocal multiple myeloma (MFMM) treated mainly with novel therapies. Based on definition (BMPCs <20% and lytic lesions/plasmacytomas, without anemia, renal insufficiency or hypercalcemia) we identified 140 patients with MFMM, among 4650 myeloma patients (3%). Twice the number of patients with typical myeloma were used as controls; 60% were <65 years and 70% had advanced bone disease. Plasmacytomas were more frequent in MFMM compared with standard myeloma (68% vs 15%, P <.05). Adverse prognostic parameters (high lactate dehydrogenase, advanced stage, high risk cytogenetics, immunoparesis) were less common in patients with MFMM compared with controls (P <.05); 90% received novel agents and 47% underwent autologous transplantation upfront; 90% achieved an objective response; 70% had at least very good partial response which was significantly higher compared with controls (P <.05). After a median follow-up of 52 months, 33 patients have died. Early death (<12 months) was infrequent in MFMM. Median progression-free survival and overall survival (OS) were 46 and 129 months respectively, both significantly longer compared with controls (P <.001). Proteasome inhibitor (PI)-based therapy was the only independent predictor for OS in the multivariate analysis (HR: 3.9; P <.001). In conclusion, MFMM is a distinct entity presented in young and elderly subjects, characterized by limited bone marrow infiltration, advanced bone disease and frequent presence of plasmacytomas; MFMM patients have less often adverse prognostic features and achieve excellent responses and prolonged OS especially when treated with PI-based therapies. Novel imaging will help in a more accurate classification of this entity.

Original languageEnglish
Pages (from-to)465-471
Number of pages7
JournalAmerican Journal of Hematology
Volume95
Issue number5
DOIs
StatePublished - 1 May 2020

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