Bone-Related Extramedullary Disease in Newly Diagnosed Myeloma Patients is an Independent Poor Prognostic Predictor

CAR-T cell therapy for patients with extramedullary multiple myeloma：Opportunities and challenges

Multiple myeloma (MM) is a hematological malignancy characterized by abnormal proliferation of clonal plasma cells, which is usually confined to the bone marrow (BM). But some malignant plasma cells grow independently of the BM, called extramedullary disease (EMD). With the clinical application of proteasome inhibitors, immunomodulators, monoclonal antibodies, and hematopoietic stem cell transplantation, the overall survival of MM patients has been significantly improved, but the survival of patients with EMD is still worse than that of non-EMD patients. There are currently no specific treatment options for EMD. chimeric antigen receptor T (CAR-T) cell therapy has brought a new era of immunotherapy. The application of CAR-T has significantly benefited many MM patients, and CAR-T may be a new hope for patients with EMD in the future. This review retrospectively summarizes the mechanism and prognosis of EMD, focusing on the application and potential of CAR-T in the treatment of EMD. It is hoped that this review can provide ideas for the treatment of EMD with CAR-T in the future.

The impact of high-risk cytogenetic abnormalities in extramedullary multiple myeloma in the era of novel agents: insights from a multicenter study

PURPOSE

This study aimed to examine the impact of high-risk cytogenetic abnormalities (HRA) on the survival outcomes of multiple myeloma patients with extramedullary disease (EMD) in the era of novel agents, utilizing the largest dataset of extramedullary multiple myeloma patients in China.

METHODS

This study included a total of 371 patients with EMD, comprising 113 patients with de novo EME and 258 patients with EMB.

RESULTS

Patients with one HRA and those with ≥ 2 HRA demonstrated significantly worse overall survival (OS) (P < 0.01) and progression-free survival (PFS) (P < 0.01) compared to patients without HRA. Additionally, 1q21 gain/amplification (1q21 +) remained a predictor of poor prognosis in EMD. CD38 monoclonal antibody-based therapy and single transplantation were less effective in improving survival outcomes for EMD with ≥ 2 HRA. Multivariable analysis identified LDH levels > 250 U/L, creatinine levels > 177 μmol/L, extramedullary extraosseous (EME), 1 HRA, and ≥ 2 HRA as independent adverse prognostic factors in patients with EMD.

CONCLUSION

Patients with EMD who had ≥ 2 HRA experienced an extremely poor prognosis, which could not be improved by single transplantation or CD38 monoclonal antibody-based treatment. The number of HRA could serve as an important factor in guiding treatment choices and predicting prognosis in patients with EMD. Furthermore, 1q21 + remained a significant factor associated with worse survival outcomes in EMD.

Clinical Value of FDG-PET/CT in Multiple Myeloma: An Update

FDG-PET/CT is a standardized imaging technique that has reached a great importance in the management of patients affected by Multiple Myeloma. It is proved, in fact, that it allows a deep evaluation of therapy efficacy and provides several prognostic indexes both at staging and after therapy. For this reason, it is now recognised as a gold standard for therapy assessment. Beside this, in reacent years FDG-PET/CT contribution to the understanding of Multiple Myeloma has progressively grown. Papers have been published analyzing the prognostic value of active disease volume measurement and standardization issues, the meaning of FDG positive paramedullary and extrameduallary disease, the prognostic impact of FDG positive minimal residual disease, the relation between focal lesions and clonal eterogenity of this disease and the comparison with whole body DWI-MR in terms of detection and therapy assessment. These newer aspects not of clinical impact yet, of FDG-PET/CT in Multiple Myeloma will be presented and discussed in this review.