Background
Methods
Patients
Follow-up
Statistical analysis
Results
Patient characteristics
Characteristic | All (n = 33) | RT ( n = 13) | Non-RT ( n = 20) | |
---|---|---|---|---|
No. of patients (%) | No. of patients (%) | No. of patients (%) | p value * | |
Median age, year (range) | 45 (25–68) | 51 (25–68) | 45 (28–63) | 0.592 |
Gender | ||||
Male | 24 (73) | 12 (92) | 12 (60) | 0.056 |
Female | 9 (27) | 1 (8) | 8 (40) | |
ECOG performance status | ||||
1 | 6 (18) | 2 (15) | 4 (20) | 0.451 |
2 | 11 (33) | 6 (46) | 5 (25) | |
3 | 16 (48) | 5 (39) | 11 (55) | |
Number of POEMS features | ||||
≤7 features | 19 (58) | 7 (54) | 12 (60) | 1.000 |
>7 features | 14 (42) | 6 (46) | 8 (40) | |
Type of M-protein | ||||
IgG | 17 (52) | 8 (62) | 9 (45) | 0.305 |
IgA | 13 (39) | 5 (38) | 8 (40) | |
IgG and IgA | 3 (9) | 0 (0) | 3 (15) | |
Type of plasma cell-proliferative disorder | ||||
OSM | 13 (39) | 8 (62) | 5 (25) | 0.067 |
CD | 4 (12) | 0 (0) | 4 (20) | 0.136 |
OSM + CD | 10 (30) | 5 (38) | 5 (25) | 0.461 |
VEGF elevation without gross lesion | 6 (18) | 0 (0) | 6 (30) | 0.060 |
Plasma cell component in bone marrow | ||||
≤5% | 20 (61) | 8 (62) | 12 (60) | 1.000 |
>5% | 13 (39) | 5 (38) | 8 (40) | |
Abnormal clonal plasma cells in bone marrow | ||||
Absent | 28 (85) | 13 (100) | 15 (75) | 0.131 |
Present | 5 (15) | 0 (0) | 5 (25) | |
Laboratory findings | ||||
ESR >20 mm/h | 16 (48) | 5 (38) | 11 (55) | 1.000 |
Hemoglobin <11 g/dL | 2 (6) | 0 (0) | 2 (10) | 0.508 |
Hemoglobin >16 g/dL | 5 (15) | 4 (31) | 1 (5) | 0.066 |
Platelets >450 x 103/μL | 11 (33) | 2 (15) | 9 (45) | 0.128 |
Creatinine clearance <60 mL/min | 5 (15) | 0 (0) | 5 (25) | 0.131 |
Characteristic | All (n = 33) | RT ( n = 13) | Non-RT ( n = 20) | p value * |
---|---|---|---|---|
No. of patients (%) | No. of patients (%) | No. of patients (%) | ||
Polyneuropathy | ||||
Peripheral neuropathy | 33 (100) | 13 (100) | 20 (100) | N/A |
CSF protein >50 mg/dL | 18/20 (90) | 5/5 (100) | 13/15 (87) | 1.00 |
Organomegaly | ||||
Hepatomegaly | 16 (48) | 6 (46) | 10 (50) | 1.000 |
Splenomegaly | 18 (55) | 7 (54) | 11 (55) | 0.614 |
Lymphadenopathy | 15 (45) | 5 (38) | 10 (50) | 0.722 |
Endocrinopathy | ||||
Diabetes mellitus | 6 (18) | 3 (23) | 3 (15) | 0.659 |
Hypothyroidism | 15 (45) | 3 (23) | 12 (60) | 0.072 |
Gonadal axis abnormality | 10 (30) | 3 (23) | 7 (35) | 0.701 |
Adrenal axis abnormality | 8 (24) | 5 (38) | 3 (15) | 0.213 |
Hyperparathyroidism | 0 (0) | 0 (0) | 0 (0) | N/A |
Skin changes | ||||
Hyper-pigmentation | 25 (76) | 11 (85) | 14 (70) | 0.431 |
Acrocyanosis and plethora | 1 (3) | 0 (0) | 1 (5) | 1.000 |
Hemangioma/telangiectasia | 0 (0) | 0 (0) | 0 (0) | N/A |
Hypertrichosis | 16 (48) | 6 (46) | 10 (50) | 1.000 |
Extravascular volume overload | ||||
Peripheral edema | 19 (58) | 6 (46) | 13 (65) | 0.472 |
Ascites | 12 (36) | 1 (8) | 11 (55) | 0.009 |
Pleural effusion | 13 (39) | 1 (8) | 12 (60) | 0.004 |
Pericardial effusion | 7 (21) | 0 (0) | 7 (35) | 0.027 |
Types of bone lesion | ||||
Osteolytic | 4 (12) | 2 (15) | 2 (10) | 0.488 |
Osteosclerotic | 14 (42) | 7 (54) | 7 (35) | |
Mixed | 5 (15) | 4 (31) | 1 (5) | |
No. of bone lesion | ||||
None | 10 (30) | 0 (0) | 10 (50) | 0.008 |
Solitary | 11 (33) | 7 (54) | 4 (20) | |
Multiple | 12 (36) | 6 (46) | 6 (30) |
Variable | No. of case (%) | Median | Range |
---|---|---|---|
Radiotherapy | 13 (100) | ||
Irradiated site | |||
Spine | 6 (46) | N/A | N/A |
Pelvic bone | 5 (38) | N/A | N/A |
Lymph nodes | 2 (15) | N/A | N/A |
No. of irradiated bone lesions | |||
Single | 7 (54) | 1 | 1 |
Multiple | 6 (46) | 4 | 2-6 |
Total dose, Gy | 13 (100) | 45 | 30-50 |
Fraction size, Gy | 13 (100) | 2 | 1.8-3 |
Chemotherapy | 25 (100) | ||
Melphalan and prednisolone | 4 (16) | N/A | N/A |
Vincristine, doxorubicin, and dexamethasone | 2 (8) | N/A | N/A |
High-dose chemotherapy with APBSCT | 15 (60) | N/A | N/A |
Others | 4 (16) | N/A | N/A |
Treatment responses
Feature | No. of Pts, | Clinical response | Hematologic response | ||||||
---|---|---|---|---|---|---|---|---|---|
No. of patients (%) | No. of patients (%) | ||||||||
Improved | Mixed | Stable | Progression | CR H | VGPR H | PR H | NR H | ||
RT | 4 | 3 (75) | 0 (0) | 1 (25) | 0 (0) | 1 (25) | 1 (25) | 0 (0) | 2 (50) |
CHT | 16 | 11 (69) | 1 (6) | 2 (13) | 2 (13) | 5 (31) | 2 (13) | 4 (25) | 5 (31) |
RT + CHT | 9 | 8 (89) | 0 (0) | 0 (0) | 1 (11) | 4 (44) | 1 (11) | 1 (11) | 3 (33) |
Steroid or Ig | 4 | 1 (25) | 1 (25) | 1 (25) | 1 (25) | 0 (0) | 0 (0) | 0 (0) | 4 (100) |
OSM | 13 | 11 (84) | 0 (0) | 1 (8) | 1 (8) | 6 (46) | 1 (8) | 3 (23) | 3 (23) |
CD | 4 | 2 (50) | 0 (0) | 1 (25) | 1 (25) | 0 (0) | 1 (25) | 2 (50) | 1 (25) |
OSM + CD | 10 | 7 (70) | 1 (10) | 1 (10) | 1 (10) | 3 (30) | 2 (20) | 0 (0) | 5 (50) |
VEGFe | 6 | 3 (50) | 1 (17) | 1 (17) | 1 (17) | 1 (17) | 0 (0) | 0 (0) | 5 (83) |
Survivals and prognostic factors
Factor | No. of case | 3-year PFS (%) | p value * | 3-year OS (%) | p value * |
---|---|---|---|---|---|
Age >50 years (vs. ≤50 years) | 13/20 | 53.3/62.4 | 0.931 | 56.4/66.0 | 0.259 |
Radiotherapy (Y/N) | 13/20 | 64.8/56.7 | 0.310 | 66.6/59.4 | 0.782 |
Chemotherapy (Y/N) | 25/8 | 71.5/17.5 | 0.007 | 74.1/18.2 | 0.020 |
HD Chemotherapy with ABSCT (vs. SD chemotherapy) | 15/10 | 80.8/58.3 | 0.291 | 78.8/66.7 | 0.253 |
IgG M-protein subtype (vs. other subtypes) | 17/16 | 54.4/65.6 | 0.719 | 61.1/65.8 | 0.775 |
VEGF elevation without gross lesion (vs. other subtypes) | 6/27 | 25.0/66.0 | 0.035 | 16.7/74.1 | 0.008 |
BM plasma cells more than 5% (vs. ≤5%) | 13/20 | 61.4/59.5 | 0.771 | 60.6/62.5 | 0.821 |
The presence of abnormal clonal plasma cells in BM (Y/N) | 5/28 | 60.0/60.8 | 0.249 | 80.0/60.4 | 0.552 |
Extravascular volume overload except peripheral edema (Y/N) | 16/17 | 49.2/70.0 | 0.155 | 53.5/71.1 | 0.212 |
Number of POEMS features >7 (vs. ≤7) | 14/19 | 46.4/67.7 | 0.220 | 45.9/74.2 | 0.127 |
Multiple bone lesions (vs. single bone lesion) | 12/11 | 62.3/66.3 | 0.742 | 77.9/70.7 | 0.906 |