Soft Tissue Lesions Predict Shorter Survival Than Bone Lesions in Relapsed Multiple Myeloma

Investigators in the Czech Republic have found an association between soft tissue lesions and diminished survival in patients with multiple myeloma.

Investigators in the Czech Republic have found an association between soft tissue lesions and diminished survival in patients with multiple myeloma (MM). In the paper, the lead author, Dr. Pour, stated that the goal of this study was to, “analyze the frequency and outcome of extramedullary relapse occurring in relapsed multiple myeloma patients.” Using data from 226 patients who had experienced relapses of MM over the period between 2005 and 2008, investigators found that a relapse of MM lesions occurred in extramedullary regions (ie, areas outside of the bone marrow) in almost one-fourth (24%) of patients who had experienced relapses of MM.

In these patients, the average length of survival was 38 months—just over one-third the 109-month average length of overall survival in patients who experienced relapses of MM with new lesions confined to bone marrow. Investigators determined that the probability of this difference occurring due to chance was less than .1%—a significant finding.

Of the 55 of patients with extramedullary lesions, 32 patients had lesions in soft tissue and the remaining 23 patients had lesions adjacent to bone. Among the 32 patients with soft tissue lesions, overall survival was 30 months versus the significantly longer average overall survival of 45 months in the 23 patients with lesions adjacent to bone (P = .022).

This study shows that relapses of MM that occur in areas outside of the bone marrow are associated with shorter survival than lesions that occur within bone marrow, or adjacent to bone tissue.

Early trials of new combinations of therapy are often attempted in patients who have a poorer prognosis. The study authors noted that patients with extramedullary lesions respond poorly to salvage therapy—even in this era of novel treatments for MM. Based on the results of this recent study, patients with extramedullary lesions and soft tissue lesions might be candidates for future trials that test novel combinations of treatments and aggressive treatment regimens that might not be attempted in patients with a better prognosis.