1Department of Hematology-Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
2Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
Copyright © 2022 Yeungnam University College of Medicine, Yeungnam University Institute of Medical Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Funding
None.
Author contributions
Conceptualization: all authors; Investigation: JML, HJC, JHM, BP, DWB; Data curation: DWB; Formal analysis: JML, HJC, JHM, SKS, DWB; Methodology: JHM, BP, DWB; Visualization: BP, DWB; Supervision: JHM, SKS, DWB; Writing-original draft: JML, SKS, BP, DWB; Writing-review & editing: HJC, JHM, SKS, DWB.
Characteristic | Data |
---|---|
No. of patients | 214 |
Age (yr) | 67 (37–87) |
>70 | 70 (32.7) |
Sex | |
Male | 88 (41.1) |
Female | 126 (58.9) |
Elevated LDH | 48 (22.4) |
Serum creatinine, >2 mg/dL | 40 (18.7) |
BM plasma cell (%) | |
<60 | 186 (86.9) |
≥60 | 28 (13.1) |
Extramdeullary plasmacytoma | 17 (7.9) |
High-risk CA by iFISHa) | 31 (14.5) |
ISS | |
I | 54 (25.2) |
II | 62 (29.0) |
III | 98 (45.8) |
R-ISS | |
I | 52 (24.3) |
II | 90 (42.1) |
III | 58 (27.1) |
Unknown | 14 (6.5) |
BM involvement patterns | |
Normal | 40 (18.7) |
Focal infiltration | 68 (31.8) |
Diffuse infiltration | 40 (18.7) |
Combined focal and diffuse infiltration | 52 (24.3) |
Salt-and-pepper | 14 (6.5) |
First-line treatment | |
VTD | 127 (59.3) |
VMP | 65 (30.4) |
Others | 22 (10.3) |
ASCT | 66 (30.8) |
Relapse | 98 (45.8) |
Death | 66 (30.8) |
Values are presented as number only, median (range), or number (%).
LDH, lactate dehydrogenase; BM, bone marrow; CA, chromosomal abnormalities; iFISH, interphase fluorescence in situ hybridization; ISS, International Staging System; R-ISS, revised International Staging System; VTD, bortezomib, thalidomide, and dexamethasone; VMP, bortezomib, melphalan, and prednisone; ASCT, autologous stem-cell transplantation.
a)High-risk cytogenetics: t(4;14), t(14;16), or del(17q).
Variable |
Progression-free survival |
Overall survival |
||||||
---|---|---|---|---|---|---|---|---|
Univariate |
Multivariate |
Univariate |
Multivariate |
|||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (yr), >65 vs. ≤65 | 1.232 (0.814–1.863) | 0.325 | 1.566 (1.021–2.403) | 0.039 | 1.195 (1.012–3.659) | 0.045 | ||
Sex, male vs. female | 0.993 (0.666–1.480) | 0.973 | 0.954 (0.585–1.678) | 0.851 | ||||
LDH, elevated vs. normal | 2.310 (1.090–2.870) | 0.001 | 3.278 (1.601–3.546) | <0.001 | 3.224 (1.383–3.786) | 0.001 | 3.690 (1.469–3.509) | <0.001 |
Serum Cr (mg/dL), ≥2 vs.<2 | 1.751 (0.753–2.890) | 0.452 | 1.127 (0.814–2.140) | 0.259 | ||||
BM plasma cell, ≥60% vs.<60% | 1.805 (0.251–3.152) | 0.421 | 0.694 (0.223–2.043) | 0.487 | ||||
EM plasmacytoma, yes vs. none | 0.463 (0.251–2.352) | 0.643 | 0.733 (0.451–5.744) | 0.464 | ||||
High-risk cytogeneticsa), yes vs. none | 3.089 (1.277–2.986) | 0.002 | 2.997 (1.281–3.262) | 0.003 | 3.797 (1.493–3.510) | <0.001 | 3.791 (1.781–3.961) | <0.001 |
ISS, II & III vs. I | 3.017 (1.573–5.728) | <0.001 | 2.903 (1.976–4.135) | <0.001 | 4.278 (2.156–8.292) | <0.001 | 4.253 (2.198–8.001) | <0.001 |
R-ISS, II & III vs. I | 2.058 (1.141–4.392) | 0.002 | 1.329 (1.013–4.493) | 0.032 | 3.647 (1.979–7.345) | 0.001 | 3.010 (1.429–7.712) | 0.002 |
Focal, diffuse, combined vs. normal, “salt-and-pepper” | 1.954 (1.297–2.944) | 0.001 | 2.176 (1.118–3.962) | <0.001 | 2.076 (1.248–3.453) | 0.004 | 2.010 (1.216–3.322) | 0.006 |
Characteristic | Data |
---|---|
No. of patients | 214 |
Age (yr) | 67 (37–87) |
>70 | 70 (32.7) |
Sex | |
Male | 88 (41.1) |
Female | 126 (58.9) |
Elevated LDH | 48 (22.4) |
Serum creatinine, >2 mg/dL | 40 (18.7) |
BM plasma cell (%) | |
<60 | 186 (86.9) |
≥60 | 28 (13.1) |
Extramdeullary plasmacytoma | 17 (7.9) |
High-risk CA by iFISH |
31 (14.5) |
ISS | |
I | 54 (25.2) |
II | 62 (29.0) |
III | 98 (45.8) |
R-ISS | |
I | 52 (24.3) |
II | 90 (42.1) |
III | 58 (27.1) |
Unknown | 14 (6.5) |
BM involvement patterns | |
Normal | 40 (18.7) |
Focal infiltration | 68 (31.8) |
Diffuse infiltration | 40 (18.7) |
Combined focal and diffuse infiltration | 52 (24.3) |
Salt-and-pepper | 14 (6.5) |
First-line treatment | |
VTD | 127 (59.3) |
VMP | 65 (30.4) |
Others | 22 (10.3) |
ASCT | 66 (30.8) |
Relapse | 98 (45.8) |
Death | 66 (30.8) |
Variable | Normal, “salt-and-pepper” (n=54) | Focal, diffuse, combined (n=160) | p-value |
---|---|---|---|
Age | 61.6 (45–83) | 66.8 (37–87) | 0.001 |
Sex | >0.999 | ||
Male | 22 (40.7) | 66 (41.3) | |
Female | 32 (59.3) | 94 (58.8) | |
ISS | <0.001 | ||
I | 34 (63.0) | 20 (12.5) | |
II | 12 (22.2) | 50 (31.3) | |
III | 8 (14.8) | 90 (56.3) | |
R-ISS | <0.001 | ||
I | 32 (59.3) | 20 (12.5) | |
II | 20 (37.0) | 84 (52.5) | |
III | 2 (3.7) | 56 (35.0) | |
ASCT | 0.003 | ||
No | 28 (51.9) | 120 (75.0) | |
Yes | 26 (48.1) | 40 (25.0) | |
Relapse | 0.014 | ||
No | 32 (59.3) | 62 (38.8) | |
Yes | 22 (40.7) | 98 (61.3) | |
Death | 0.001 | ||
No | 48 (88.9) | 100 (62.5) | |
Yes | 6 (11.1) | 60 (37.5) |
Variable | Progression-free survival |
Overall survival |
||||||
---|---|---|---|---|---|---|---|---|
Univariate |
Multivariate |
Univariate |
Multivariate |
|||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (yr), >65 vs. ≤65 | 1.232 (0.814–1.863) | 0.325 | 1.566 (1.021–2.403) | 0.039 | 1.195 (1.012–3.659) | 0.045 | ||
Sex, male vs. female | 0.993 (0.666–1.480) | 0.973 | 0.954 (0.585–1.678) | 0.851 | ||||
LDH, elevated vs. normal | 2.310 (1.090–2.870) | 0.001 | 3.278 (1.601–3.546) | <0.001 | 3.224 (1.383–3.786) | 0.001 | 3.690 (1.469–3.509) | <0.001 |
Serum Cr (mg/dL), ≥2 vs.<2 | 1.751 (0.753–2.890) | 0.452 | 1.127 (0.814–2.140) | 0.259 | ||||
BM plasma cell, ≥60% vs.<60% | 1.805 (0.251–3.152) | 0.421 | 0.694 (0.223–2.043) | 0.487 | ||||
EM plasmacytoma, yes vs. none | 0.463 (0.251–2.352) | 0.643 | 0.733 (0.451–5.744) | 0.464 | ||||
High-risk cytogenetics |
3.089 (1.277–2.986) | 0.002 | 2.997 (1.281–3.262) | 0.003 | 3.797 (1.493–3.510) | <0.001 | 3.791 (1.781–3.961) | <0.001 |
ISS, II & III vs. I | 3.017 (1.573–5.728) | <0.001 | 2.903 (1.976–4.135) | <0.001 | 4.278 (2.156–8.292) | <0.001 | 4.253 (2.198–8.001) | <0.001 |
R-ISS, II & III vs. I | 2.058 (1.141–4.392) | 0.002 | 1.329 (1.013–4.493) | 0.032 | 3.647 (1.979–7.345) | 0.001 | 3.010 (1.429–7.712) | 0.002 |
Focal, diffuse, combined vs. normal, “salt-and-pepper” | 1.954 (1.297–2.944) | 0.001 | 2.176 (1.118–3.962) | <0.001 | 2.076 (1.248–3.453) | 0.004 | 2.010 (1.216–3.322) | 0.006 |
Values are presented as number only, median (range), or number (%). LDH, lactate dehydrogenase; BM, bone marrow; CA, chromosomal abnormalities; iFISH, interphase fluorescence High-risk cytogenetics: t(4;14), t(14;16), or del(17q).
Values are presented as median (range) or number (%). Percentages may not total 100% due to rounding. ISS, International Staging System; R-ISS, revised International Staging System; ASCT, autologous stem-cell transplantation.
HR, hazard ratio; CI, confidence interval; LDH, lactate dehydrogenase; Cr, creatinine; BM, bone marrow; EM, extramedullary; ISS, International Staging System; R-ISS, revised International Staging System. High-risk cytogenetics: t(4;14), t(14;16), or del(17q).