World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website http://www.wjon.org

Original Article

Volume 3, Number 4, August 2012, pages 147-157


Detection of Skeletal Lesions by Whole Body Multidetector Computed Tomography in Multiple Myeloma has no Impact on Long-Term Outcomes Post Autologous Hematopoietic Cell Transplantation

Figures

Figure 1.
Figure 1. Rib, sternal, and vertebral body myelomatous lesions seen by WBCT (arrows) (b, c) but not conventional skeletal radiography (a).
Figure 2.
Figure 2. Incidental finding of a non-cystic, exophytic left renal mass in a patient with multiple myeloma (arrow). This mass was later found to be a renal cell carcinoma.
Figure 3.
Figure 3. Kaplan-Meier overall survival (OS) and progression-free survival (PFS) curves for the different groups of patients. P values are displayed within the figure for each comparison. Group 1: Patients who had more myelomatous bone disease detected on WBCT than CSS. Group 2: Patients without any differences between CSS and WBCT in the detection of myelomatous bone diseaseGroup 3: Patients without any myelomatous bone disease detected by either modality. Group 4: Patients with myelomatous bone lesions detected by WBCT but not by CSS.Group 5: patients in groups 3 and 4 together.

Tables

Table 1. Patient and Disease Characteristics
 
CharacteristicsGroup 1 (n = 41)Group 2 (n = 31)
Abbreviations: HCT: hematopoietic cell transplant; FISH: fluorescence in situ hybridization; ISS: international staging system; B2M: beta 2 microglobulin; WBCT: whole body computerized tomography; CSS: conventional skeletal survey; Group 1: Patients who had more myelomatous bone disease detected on WBCT than CSS; Group 2: Patients without any differences between CSS and WBCT in the detection of myelomatous bone disease.
Male/female22/1917/14
Age, median (range) years58 (25 - 75)59 (43 - 75)
Durie-Salmon/ ISS
I A/I2/193/11
II A/I12/119/11
III A/IIIB/III23/4/513/6/5
B2M, mg/L, median (range)2.27 (0.84 - 14.1)2.6 (1.45 - 69.6)
Median follow-up (range), months36 (6 - 84)31 (11 - 73)
Lines of therapy before HCT
12820
297
344
Conditioning for first autologous HCT
Melphalan3218
Busulfan/cyclophosphamide +/- etoposide913
Cytogenetics/FISH
Normal2524
Complex/hyperdiploid and del 13 by cytogenetics41
Hyperdiploid without deletions63
FISH + chromosomes 13,14, or 1733
Del Y21
Time to first auto HCT: median (range) months7 (3 - 60)7 (3 - 39)
Tandem autologous/autologous HCT54
Tandem autologous/allogeneic HCT56
Salvage autologous/autologous HCT41
Salvage autologous/allogeneic HCT62
Maintenance lenalidomide41
Maintenance thalidomide/interferon56

 

Table 2. Patient and Disease Characteristics of Group 5 (Negative Conventional Skeletal Survey) Compared to all Other Groups
 
CharacteristicGroup 5 (n = 14)All Other Patients (n = 58)
Abbreviations: HCT: hematopoietic cell transplant; FISH: fluorescence in situ hybridization; ISS: international staging system.
Male/female5/934/24
Age, median (range) years59 (47 - 75)56 (35 - 75)
Durie-Salmon stage
I A14
II A714
III A/IIIB3/333/7
International staging system
I326
II616
III37
missing29
Lines of therapy before HCT
11038
2313
317
Cytogenetics/FISH
Normal1138
Complex/hyperdiploid and del 13 by cytogenetics05
Hyperdiploid without deletions18
FISH + chromosomes 13,14, or 1724
Del Y03
Time to first autologous HCT: median (range) months6 (4 - 24)7 (3 - 60)
Tandem autologous/autologous HCT27
Tandem autologous/allogeneic HCT56
Salvage autologous/autologous HCT05
Salvage autologous/allogeneic HCT08
Maintenance lenalidomide05
Maintenance thalidomide/interferon29

 

Table 3. Risk Factor Analysis for Progression Free Survival
 
VariableUnivariateMultivariate
Hazard ratio95% CIP valueHazard ratio95% CIP value
Abbreviations: DS: Durie-Salmon stage; ISS: International staging system; FISH: fluorescence in situ hybridization; Definitions of cytogenetics: 1-poor prognosis, complex abnormalities with del 13, 17p, or t(4:14), or any of these abnormalities; 2- Intermediate prognosis, normal chromosomes, Del 13 by FISH only; 3- Good prognosis, hyperdiploidy, t(11,14).
Disease stage DS
IIA vs IA0.8840.292 - 2.6750.82741.1660.342 - 3.9720.8058
IIIA vs IA1.3370.465 - 3.8450.28981.7220.575 - 5.1570.3311
IIIB vs IA1.4390.420 - 4.9300.33504.2190.994 - 17.9020.0509
Disease stage ISS
II vs I1.4670.800 - 2.6920.21561.410.699 - 2.8450.3376
III vs I0.7420.304 - 1.8080.51100.5330.189 - 1.5080.2358
Cytogenetics/FISH
3 vs 11.1780.496 - 2.7970.71070.9970.391 - 2.440.9598
2 vs 11.7500.483 - 6.2540.38942.4110.638 - 9.1090.1943
Negative vs Positive conventional
skeletal survey
0.5220.253 - 1.0770.07840.3960.172 - 0.9100.0291
Gender
Male vs Female0.9980.577 - 1.7260.99441.0880.603 - 1.9630.7795
Age1.0050.977 - 1.0330.74521.0050.973 - 1.0390.7534

 

Table 4. Risk Factor Analysis for Overall Survival
 
VariableUnivariateMultivariate
Hazard ratio95% CIP valueHazard ratio95% CIP value
Abbreviations: DS: Durie-Salmon stage; ISS: International staging system; FISH: fluorescence in situ hybridization; Definitions of cytogenetics: 1- poor prognosis,complex abnormalities with del 13, 17p, or t(4:14), or any of these abnormalities; 2- Intermediate prognosis, normal chromosomes, Del 13 by FISH only; 3- good prognosis, hyperdiploidy, t(11,14).
Disease stage DS
IIA vs IA0.7540.083 - 6.8760.80261.270.111 - 14.4850.8472
IIIA vs IA2.1160.275 - 16.2640.47154.570.534 - 39.1470.1655
IIIB vs IA3.8390.461 - 31.9470.213311.9721.196 - 116.230.0346
Disease stage ISS
II vs I7.702.765 - 21.8370.00017.2342.179 - 24.0150.0012
III vs I4.5791.321 - 15.8720.01643.4260.809 - 14.5160.0946
Cytogenetics/FISH
3 vs 11.0440.308 - 3.5390.94520.260.058 - 1.1540.0763
2 vs 11.0890.181 - 6.540.92570.2320.031 - 1.7240.1532
Negative vs Positive conventional skeletal survey0.1360.018 - 1.010.0510.0610.007 - 0.5540.013
Gender Male vs Female0.8030.358 - 1.7980.5930.8750.37 - 2.0690.761
Age1.030.987 - 1.0740.18091.0470.987 - 1.1110.126

 

Table 5. Comparison of Survival Curves Using the Logrank Test
 
Groups of patientsMedian PFS (months)Median OS (months)Hazard ratio95% confidence intervalP value
Abbreviations: Group 1: Patients who had more myelomatous bone disease detected on WBCT than CSS; Group 2: Patients without any differences between CSS and WBCT in the detection of myelomatous bone disease; Group 3: Patients without any myelomatous bone disease detected by either modality; Group 4: Patients with myelomatous bone lesions detected by WBCT but not by CSS; Group 5: patients in groups 3 and 4 together.
Groups 1 vs. 217 vs. 2784 vs. not yet reachedPFS: 0.627
OS 1.001
PFS: 0.36 - 1.1
OS: 0.43 - 2.34
PFS: 0.09
OS: 0.997
Groups 3 vs. 428 vs. 36.5Not yet reached vs. 60PFS: 1.544
OS: 0.00
PFS: 0.41 - 6.66
OS: 0.0008 - 3.18
PFS: 0.487
OS: 0.157
Groups 5 vs. all others32 vs. 17Not yet reached vs. 84PFS: 0.47
OS: 0.145
PFS: 0.28 - 0.93
OS: 0.13 - 0.87
PFS: 0.0292
OS: 0.0258