A case-control study of multiple myeloma patients with central nervous system involvement
10.3760/cma.j.issn.0253-2727.2022.12.007
- VernacularTitle:累及中枢神经系统多发性骨髓瘤患者的病例对照研究
- Author:
Lu LI
1
;
Zhongyuan FENG
;
Pei GUO
;
Haiyan HE
;
Jing LU
;
Jin LIU
;
Wanting QIANG
;
Hua JIANG
;
Juan DU
;
Weijun FU
Author Information
1. 海军军医大学第二附属医院血液科，全军骨髓瘤与淋巴瘤疾病中心，上海 200003
- Keywords:
Multiple myeloma;
Central nervous system;
Treatment;
Prognosis
- From:
Chinese Journal of Hematology
2022;43(12):1016-1020
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the treatment options for multiple myeloma patients with central nervous system involvement (CNS-MM) , as well as their clinical characteristics and prognostic factors.Methods:Between January 2011 and January 2022 our center diagnosed 18 people with CNS-MM. A retrospective analysis was done on the clinical information from the initial diagnosis and central nervous system involvement, and it was compared to 1∶3 matched newly diagnosed MM from the same period. Analysis was done on the clinical characteristics and survival rates of the two groups.Results:In patients with CNS-MM, the median time of onset was 14.2 (0.9-79.6) months and the median overall survival (OS) was 30.5 months from initial diagnosis and only 3.8 months in patients after CNS involvement. The CNS-MM patients showed more IgD type ( P=0.010) , severer anemia ( P=0.014) , a higher proportion of bone marrow plasma cells ( P=0.013) , more extramedullary lesions ( P=0.001) , and increased lactic dehydrogenase (LDH) ( P=0.009) when compared to the control group. Lenalidomide or pomalidomide-based combinations had higher rates of hematology and CNS remission than bortezomib or daratumumab-based regimens (75.0% vs 16.7% , P=0.019) . Patients who received IMiD-based regimens and had 2 high-risk factors at initial diagnosis (high LDH and extramedullary lesions) had a significantly lower incidence of CNS-MM ( P=0.026) . At the initial diagnosis, LDH ( P=0.008, HR=7.319, 95% CI 1.663-32.219) and extramedullary lesions ( P=0.006, HR=8.054, 95% CI 1.828-35.486) were independent risk factors for the occurrence of CNS-MM. Conclusion:Patients with CNS-MM had a poor prognosis. Patients with high LDH or extramedullary lesions at the time of the initial diagnosis are more likely to have CNS-MM. The prognosis of this patient may be improved by immunoregulator-based therapy.
