Analysis of clinical characteristics, treatment response, and prognosis among 67 patients with anaplastic multiple myeloma.

Abstract

Background: Anaplastic multiple myeloma (AMM) is a type of distinctive MM with a poor prognosis. AMM is mostly reported as individual cases, an accurate incidence and strict clinical definition are lacking.

Methods: Sixty-seven patients with AMM were identified and then analyzed in the clinical database of patients with MM from January 2017 to September 2024.

Results: The incidence of AMM among patients with MM was 3.3%. The IgD type accounted for 11.9% of patients, with 40.3% and 53.7% kappa and lambda light chains, respectively. Plasmablasts with larger diameters and multinuclear variations accounted for 46.7% from bone marrow or extramedullary disease (EMD) based on pathologic morphology; the average Ki-67 was 64.8%. The incidence of EMD was 49.3%. Lactic dehydrogenase (LDH) was elevated in 44.8% of patients and 49.3% of patients were International Staging System (ISS) III. The frequencies of 1q21, t (4; 14), and t (14; 16) in high-risk genes were 60.5%, 39.5%, and 18.4%, respectively. Double and triple gene hits were detected in 36.8% and 13.2% of patients, respectively. Fifty-six patients received treatment with bortezomib-based regimens. The progression-free survival (PFS) and overall survival (OS) of AMM patients in the autologous stem cell transplantation (ASCT) group were prolonged compared to patients who did not undergo ASCT with a median PFS and OS of 5.0 versus 25.0 and 17.0 versus 36.0 months, respectively (P = 0.0246 and P = 0.0119, respectively). At the time of the last follow-up, 71.4% of patients had died with 77.5% experiencing disease progression. A high neutrophil-to-lymphocyte ratio (NLR) and no ASCT were also independent prognostic factors for AMM patients.

Conclusions: The incidence of AMM is rare. The characteristics of these AMM patients included extensive proliferation of plasmablasts and widespread EMD formation, AMM patients also exhibit more invasive clinical manifestations and a short survival. Patients who underwent sequential ASCT after receiving bortezomib-based regimens partially overcame the poor prognosis of AMM.