title: The impact of extramedullary disease at presentation on the outcome of myeloma.
abstract: This study was conducted to compare the presenting features and outcome of newly-diagnosed myeloma with and without extramedullary (EM) manifestations and to determine the optimum treatment. Seventy-five (16.3%) patients with EM involvement at diagnosis were compared with 384 cases without EM disease. EM patients had a more favourable International Staging System and a different distribution of myeloma isotypes. When adjusted according to the independent risk factors, patients in the EM group treated with chemotherapy alone had significantly shorter overall survival (OS) compared to those without EM disease receiving similar treatment. High-dose treatment (HDT) was associated with significantly improved OS in both groups; however, it had more impact on OS among EM group, overcoming the negative prognostic impact of presenting EM disease. Patients in the EM group treated with HDT have a similar outcome to those without EM manifestations treated with HDT. HDT should form an integral component of first-line treatment for patients with EM disease whenever possible.
authors.affiliation: Haemato-Oncology Unit, Royal Marsden Hospital, Surrey, UK.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.forename: Faith E
authors.initials: FE
authors.lastname: Davies
authors.forename: Kevin
authors.initials: K
authors.lastname: Boyd
authors.forename: Karen
authors.initials: K
authors.lastname: Thomas
authors.forename: Sharon
authors.initials: S
authors.lastname: Dines
authors.forename: Radovan M
authors.initials: RM
authors.lastname: Saso
authors.forename: Mike N
authors.initials: MN
authors.lastname: Potter
authors.forename: Mark E
authors.initials: ME
authors.lastname: Ethell
authors.forename: Bronwen E
authors.initials: BE
authors.lastname: Shaw
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents