BONE MARROW RETICULIN FIBROSIS AS A PROGNOSTIC MARKER IN NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS TREATED IN THE ERA OF NOVEL AGENTS
(Abstract release date: 05/19/16)
EHA Library. Suriu C. 06/09/16; 134876; PB1976
Dr. Celia Suriu
Contributions
Contributions
Abstract
Abstract: PB1976
Type: Publication Only
Background
Different prognostic strategies are used in order to stratify newly diagnosed multiple myeloma (MM) patients at the time of diagnosis. The survival of MM patients has improved significantly in the last decade, attributed especially to the use of novel therapeutic agents (immunomodulatory drugs and proteosome inhibitors). Bone marrow (BM) biopsies from patients with MM at diagnosis may show different degrees of reticulin fibrosis, but its clinical significance is unclear.
Aims
To evaluate the prognostic impact of the BM reticulin fibrosis in our cohort of patients, treated in the era of novel agents.
Methods
We retrospectively reviewed the medical records of 51 patients treated between 2006 and 2014 at Galilee Medical Center, Nahariya, Israel. BM biopsies were graded for reticulin fibrosis (grades 0-3) based on the the European consensus report. Overall survival (OS) was measured from the time of diagnosis to the date of death or last follow-up. Progression free survial (PFS) was measured from the time of diagnosis to the date of progression or death. Univariate and multivariate survival analysis was performed using Cox Regression Model and Kaplan-Meier method with Log Rank (Mantel-Cox) test.
Results
51 newly diagnosed MM patients were evaluated. The median age was 69 years (range: 47-88 years); 29 (56.9%) patients were male. The paraprotein type was: 28 (55%) IgG, 12 (23.5%) Light Chain and 9 (17.6%) IgA; 12 (24.5%) patients were ISS I, 12 (24.5%) were ISS II, 25 (51%) were ISS III. 31 (64.6%) patients were treated with chemotherapy, 12 (25 %) were treated with chemotherapy followed by ASCT and 5 (10.4%) patients had conservative therapy. 41 patients (80.4%) were treated with novel agents at diagnosis. The median follow-up for the entire cohort after the diagnosis was 30.3 months (range 0.2-112.7 months). At the time of writing, 30 (58.8%) patients were living. For the statistic analysis we separated the patients into two groups: low grade fibrosis (grade 0-1) versus high grade fibrosis (grade 2-3). BM fibrosis characteristics did not differ significantly among patients with respect to age, sex, paraprotein type and albumin level. Patients with higher grade of fibrosis were more likely to have lower hemoglobin level (p=0.009), higher creatinine (p=0.007) and calcium level (p=0.008) with ISS III (p=0.002). Univariate analysis of overall survival (OS) showed that only age < 65 (p=0.001), and treatment with novel agents (p=0.004) were significantly associated with better survival. Lower degree of fibrosis showed a tendency, not statistically significant for better survival: 72 mo vs 40 mo (p=0.14). On univariate analysis of PFS only lower grade of fibrosis was significantly associated with better survival (p=0.024) and a tendency for longer PFS with lower grade of fibrosis was seen in multivariate analysis of PFS (p=0.064). In subgroup analysis for patients treated with novel agents lower degree of fibrosis was still statistically significant for PFS (p=0.02).
Conclusion
In our cohort of patients, the degree of fibrosis was statistically significant for survival of MM patients, especially for PFS. This survival benefit is seen also in patients treated with novel agents. These results confirm that examination of the grade of fibrosis of the bone marrow at time of diagnosis of MM patients can provide better prognostic significance. These results should be validated in other cohorts.
Session topic: E-poster
Keyword(s): Bone Marrow Fibrosis, Myeloma
Type: Publication Only
Background
Different prognostic strategies are used in order to stratify newly diagnosed multiple myeloma (MM) patients at the time of diagnosis. The survival of MM patients has improved significantly in the last decade, attributed especially to the use of novel therapeutic agents (immunomodulatory drugs and proteosome inhibitors). Bone marrow (BM) biopsies from patients with MM at diagnosis may show different degrees of reticulin fibrosis, but its clinical significance is unclear.
Aims
To evaluate the prognostic impact of the BM reticulin fibrosis in our cohort of patients, treated in the era of novel agents.
Methods
We retrospectively reviewed the medical records of 51 patients treated between 2006 and 2014 at Galilee Medical Center, Nahariya, Israel. BM biopsies were graded for reticulin fibrosis (grades 0-3) based on the the European consensus report. Overall survival (OS) was measured from the time of diagnosis to the date of death or last follow-up. Progression free survial (PFS) was measured from the time of diagnosis to the date of progression or death. Univariate and multivariate survival analysis was performed using Cox Regression Model and Kaplan-Meier method with Log Rank (Mantel-Cox) test.
Results
51 newly diagnosed MM patients were evaluated. The median age was 69 years (range: 47-88 years); 29 (56.9%) patients were male. The paraprotein type was: 28 (55%) IgG, 12 (23.5%) Light Chain and 9 (17.6%) IgA; 12 (24.5%) patients were ISS I, 12 (24.5%) were ISS II, 25 (51%) were ISS III. 31 (64.6%) patients were treated with chemotherapy, 12 (25 %) were treated with chemotherapy followed by ASCT and 5 (10.4%) patients had conservative therapy. 41 patients (80.4%) were treated with novel agents at diagnosis. The median follow-up for the entire cohort after the diagnosis was 30.3 months (range 0.2-112.7 months). At the time of writing, 30 (58.8%) patients were living. For the statistic analysis we separated the patients into two groups: low grade fibrosis (grade 0-1) versus high grade fibrosis (grade 2-3). BM fibrosis characteristics did not differ significantly among patients with respect to age, sex, paraprotein type and albumin level. Patients with higher grade of fibrosis were more likely to have lower hemoglobin level (p=0.009), higher creatinine (p=0.007) and calcium level (p=0.008) with ISS III (p=0.002). Univariate analysis of overall survival (OS) showed that only age < 65 (p=0.001), and treatment with novel agents (p=0.004) were significantly associated with better survival. Lower degree of fibrosis showed a tendency, not statistically significant for better survival: 72 mo vs 40 mo (p=0.14). On univariate analysis of PFS only lower grade of fibrosis was significantly associated with better survival (p=0.024) and a tendency for longer PFS with lower grade of fibrosis was seen in multivariate analysis of PFS (p=0.064). In subgroup analysis for patients treated with novel agents lower degree of fibrosis was still statistically significant for PFS (p=0.02).
Conclusion
In our cohort of patients, the degree of fibrosis was statistically significant for survival of MM patients, especially for PFS. This survival benefit is seen also in patients treated with novel agents. These results confirm that examination of the grade of fibrosis of the bone marrow at time of diagnosis of MM patients can provide better prognostic significance. These results should be validated in other cohorts.
Session topic: E-poster
Keyword(s): Bone Marrow Fibrosis, Myeloma
Abstract: PB1976
Type: Publication Only
Background
Different prognostic strategies are used in order to stratify newly diagnosed multiple myeloma (MM) patients at the time of diagnosis. The survival of MM patients has improved significantly in the last decade, attributed especially to the use of novel therapeutic agents (immunomodulatory drugs and proteosome inhibitors). Bone marrow (BM) biopsies from patients with MM at diagnosis may show different degrees of reticulin fibrosis, but its clinical significance is unclear.
Aims
To evaluate the prognostic impact of the BM reticulin fibrosis in our cohort of patients, treated in the era of novel agents.
Methods
We retrospectively reviewed the medical records of 51 patients treated between 2006 and 2014 at Galilee Medical Center, Nahariya, Israel. BM biopsies were graded for reticulin fibrosis (grades 0-3) based on the the European consensus report. Overall survival (OS) was measured from the time of diagnosis to the date of death or last follow-up. Progression free survial (PFS) was measured from the time of diagnosis to the date of progression or death. Univariate and multivariate survival analysis was performed using Cox Regression Model and Kaplan-Meier method with Log Rank (Mantel-Cox) test.
Results
51 newly diagnosed MM patients were evaluated. The median age was 69 years (range: 47-88 years); 29 (56.9%) patients were male. The paraprotein type was: 28 (55%) IgG, 12 (23.5%) Light Chain and 9 (17.6%) IgA; 12 (24.5%) patients were ISS I, 12 (24.5%) were ISS II, 25 (51%) were ISS III. 31 (64.6%) patients were treated with chemotherapy, 12 (25 %) were treated with chemotherapy followed by ASCT and 5 (10.4%) patients had conservative therapy. 41 patients (80.4%) were treated with novel agents at diagnosis. The median follow-up for the entire cohort after the diagnosis was 30.3 months (range 0.2-112.7 months). At the time of writing, 30 (58.8%) patients were living. For the statistic analysis we separated the patients into two groups: low grade fibrosis (grade 0-1) versus high grade fibrosis (grade 2-3). BM fibrosis characteristics did not differ significantly among patients with respect to age, sex, paraprotein type and albumin level. Patients with higher grade of fibrosis were more likely to have lower hemoglobin level (p=0.009), higher creatinine (p=0.007) and calcium level (p=0.008) with ISS III (p=0.002). Univariate analysis of overall survival (OS) showed that only age < 65 (p=0.001), and treatment with novel agents (p=0.004) were significantly associated with better survival. Lower degree of fibrosis showed a tendency, not statistically significant for better survival: 72 mo vs 40 mo (p=0.14). On univariate analysis of PFS only lower grade of fibrosis was significantly associated with better survival (p=0.024) and a tendency for longer PFS with lower grade of fibrosis was seen in multivariate analysis of PFS (p=0.064). In subgroup analysis for patients treated with novel agents lower degree of fibrosis was still statistically significant for PFS (p=0.02).
Conclusion
In our cohort of patients, the degree of fibrosis was statistically significant for survival of MM patients, especially for PFS. This survival benefit is seen also in patients treated with novel agents. These results confirm that examination of the grade of fibrosis of the bone marrow at time of diagnosis of MM patients can provide better prognostic significance. These results should be validated in other cohorts.
Session topic: E-poster
Keyword(s): Bone Marrow Fibrosis, Myeloma
Type: Publication Only
Background
Different prognostic strategies are used in order to stratify newly diagnosed multiple myeloma (MM) patients at the time of diagnosis. The survival of MM patients has improved significantly in the last decade, attributed especially to the use of novel therapeutic agents (immunomodulatory drugs and proteosome inhibitors). Bone marrow (BM) biopsies from patients with MM at diagnosis may show different degrees of reticulin fibrosis, but its clinical significance is unclear.
Aims
To evaluate the prognostic impact of the BM reticulin fibrosis in our cohort of patients, treated in the era of novel agents.
Methods
We retrospectively reviewed the medical records of 51 patients treated between 2006 and 2014 at Galilee Medical Center, Nahariya, Israel. BM biopsies were graded for reticulin fibrosis (grades 0-3) based on the the European consensus report. Overall survival (OS) was measured from the time of diagnosis to the date of death or last follow-up. Progression free survial (PFS) was measured from the time of diagnosis to the date of progression or death. Univariate and multivariate survival analysis was performed using Cox Regression Model and Kaplan-Meier method with Log Rank (Mantel-Cox) test.
Results
51 newly diagnosed MM patients were evaluated. The median age was 69 years (range: 47-88 years); 29 (56.9%) patients were male. The paraprotein type was: 28 (55%) IgG, 12 (23.5%) Light Chain and 9 (17.6%) IgA; 12 (24.5%) patients were ISS I, 12 (24.5%) were ISS II, 25 (51%) were ISS III. 31 (64.6%) patients were treated with chemotherapy, 12 (25 %) were treated with chemotherapy followed by ASCT and 5 (10.4%) patients had conservative therapy. 41 patients (80.4%) were treated with novel agents at diagnosis. The median follow-up for the entire cohort after the diagnosis was 30.3 months (range 0.2-112.7 months). At the time of writing, 30 (58.8%) patients were living. For the statistic analysis we separated the patients into two groups: low grade fibrosis (grade 0-1) versus high grade fibrosis (grade 2-3). BM fibrosis characteristics did not differ significantly among patients with respect to age, sex, paraprotein type and albumin level. Patients with higher grade of fibrosis were more likely to have lower hemoglobin level (p=0.009), higher creatinine (p=0.007) and calcium level (p=0.008) with ISS III (p=0.002). Univariate analysis of overall survival (OS) showed that only age < 65 (p=0.001), and treatment with novel agents (p=0.004) were significantly associated with better survival. Lower degree of fibrosis showed a tendency, not statistically significant for better survival: 72 mo vs 40 mo (p=0.14). On univariate analysis of PFS only lower grade of fibrosis was significantly associated with better survival (p=0.024) and a tendency for longer PFS with lower grade of fibrosis was seen in multivariate analysis of PFS (p=0.064). In subgroup analysis for patients treated with novel agents lower degree of fibrosis was still statistically significant for PFS (p=0.02).
Conclusion
In our cohort of patients, the degree of fibrosis was statistically significant for survival of MM patients, especially for PFS. This survival benefit is seen also in patients treated with novel agents. These results confirm that examination of the grade of fibrosis of the bone marrow at time of diagnosis of MM patients can provide better prognostic significance. These results should be validated in other cohorts.
Session topic: E-poster
Keyword(s): Bone Marrow Fibrosis, Myeloma
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