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KMID : 0923620170170040250
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Immune Network
2017 Volume.17 No. 4 p.250 ~ p.260
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Distinct Clinical Outcomes between Paramedullary and Extramedullary Lesions in Newly Diagnosed Multiple Myeloma
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Batsukh Khishigjargal
Lee Sung-Eun
Min Gi-June
Park Sung-Soo
Jeon Young-Woo
Yoon Jae-Ho
Cho Byung-Sik
Eom Ki-Seong
Kim Yoo-Jin
Kim Hee-Je
Lee Seok
Cho Seok-Goo
Kim Dong-Wook
Lee Jong-Wook
Min Woo-Sung
Min Chang-Ki
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Abstract
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This retrospective study aimed to compare the clinical features of paramedullary lesions (PLs) and extramedullary lesions (ELs) of plasmacytomas at diagnosis, using positron emission tomography integrated with computed tomography, using glucose labeled with the positron-emitting radionuclide 18F (18F-FDG-PET/CT) in newly diagnosed multiple myeloma (NDMM), and to address their prognostic impact. Sixty-four patients with NDMM presenting ELs (n=22) and/or PLs (n=42) were included. Patients with ELs at initial presentation had unfavorable laboratory parameters of calcium and lactate dehydrogenase, a higher percentage of bone marrow plasma cells, and showed a trend toward advanced international staging system (ISS), compared to patients with PLs. Using X-ray imaging, high bone disease (HBD) was observed in 50% and 71% of patients with ELs and PLs, respectively. After a median follow-up of 29.2 months (range, 3.4?76.5 months) in survivors, patients with ELs had a significantly lower overall survival (OS) (p=0.033) than patients with PLs did, whereas the progression-free survival (PFS) did not differ significantly (p=0.818). However, the PFS after 1st progression was significantly worse in patients with ELs than in those with PLs (p=0.017). In the multivariate analyses, the negative impact of initial ELs on OS (p=0.033) was sustained. Our results demonstrated the different clinical features and outcomes of ELs and PLs in NDMM. Patients with initial ELs showed a shorter PFS after 1st progression, which translated into poor OS, providing insight into the different biological effect of ELs.
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KEYWORD
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Multiple myeloma, Plasmacytomas, 18F-FDG-PET/CT
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