Efficacy analysis of bortezomib-based induction followed with autologous hematopoietic stem cell transplantation in newly diagnosed multiple myeloma with extramedullary disease

Objective:To determine the effect of bortezomib-based induction followed with autologous hematopoietic stem cell transplantation(ASCT)on the outcomes of newly-diagnosed multiple myeloma(MM)patients with extramedullary disease(EMD).Method:A total of 244newly-diagnosed and untreated symptomatic MM patients were retrospectively analyzed.The primary endpoints were overall survival(OS)and progression free survival(PFS).Result:Sixty-six(27.0%)of the study population had EMD at diagnosis.The subjects were divided into three groups according to treatment strategies:conventional chemotherapy(n=59),novel agents-based regimens without ASCT(n=87),and bortezomib-based induction followed with ASCT(n=98).In the conventional chemotherapy group,PFS of patients with EMD was significantly shorter than that of patients without EMD(7.433 vs.25.400 months,P=0.024).However,in the group treated with novel agents and the group treated with bortezomib-based induction followed with ASCT,there was no significant difference in the median PFS between EMD patients and those without EMD.Bortezomib-based induction followed with ASCT improved PFS in EMD patients as compared to those treated with conventional chemotherapy or novel agents(P0.05).In the conventional treatment group and novel drugs without ASCT treatment group,the median OS of patients with EMD was significantly shorter than those without EMD(21.033 vs.34.667 months,P=0.043;10.400 vs.44.300 months,P=0.004).While in the group treated with bortezomib-based induction followed with ASCT,there was no significant difference in median OS between the patients with and without EMD(P=0.325).Bortezomib-based induction followed with ASCT improved OS in EMD patients as compared to those treated with conventional chemotherapy or novel agents only(P0.005).Conclusion:Bortezomib-based induction followed with ASCT significantly improves survival of newly diagnosed MM with EMD,and overcomes the negative prognostic impact of EMD on MM.