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. 2024 Jun 16:47:100615.
doi: 10.1016/j.jbo.2024.100615. eCollection 2024 Aug.

Percutaneous vertebroplasty/kyphoplasty contributes to the improved outcome in patients with newly diagnosed multiple myeloma: A single center cohort study

Fujing Zhang  1 , Shuzhong Liu  2 , Xi Zhou  2 , Wei Wang  1 , Congwei Jia  3 , Qin Wang  4 , Yong Liu  2 , Junling Zhuang  1
Affiliations

Percutaneous vertebroplasty/kyphoplasty contributes to the improved outcome in patients with newly diagnosed multiple myeloma: A single center cohort study

Fujing Zhang et al. J Bone Oncol. .

Abstract

Objective: To evaluate the efficacy and prognosis of percutaneous vertebroplasty/kyphoplasty (PVP/PKP) in patients with newly diagnosed multiple myeloma (NDMM).

Methods: Clinical data of NDMM patients who underwent PVP/PKP during front-line regimen at Peking Union Medical College Hospital from January 1, 2003, to June 30, 2023, were analyzed. Patients with comparable bone diseases not receiving orthopedic surgery were selected as controls. Visual analogue scale (VAS) score, progression-free survival (PFS), and overall survival (OS) were compared.

Results: Baseline characteristics were matched between the surgical group (n = 51 with 56 surgeries) and non-surgical group (n = 102), including demographics, tumor load, International Staging System (ISS), bone diseases, cytogenetic abnormalities, first-line treatment, and autologous stem-cell transplantation (ASCT). Bone lesions for PVP/PKP were located at thoracic vertebrae (53.6 %, 30/56) or lumbosacral vertebrae (46.4 %, 26/56). The postoperative VAS score was significantly improved (2.25 ± 0.81 vs 5.92 ± 1.05, P < 0.001). The median follow-up time was 51[38-70] months. Kaplan-Meier survival analysis suggested that both PFS (37[17-89] vs 23[12-61] months, HR 0.648, 95 %CI 0.431-0.973, P = 0.047) and OS (not reached vs 66[28-NR] months, HR 0.519, 95 %CI 0.296-0.910, P = 0.045) were significantly prolonged in the surgical group. COX multivariate analysis suggested that PVP/PKP was an independent prognostic factor for PFS (P = 0.021, HR 0.589, 95 %CI 0.376-0.922) and OS (P = 0.038, HR 0.496, 95 %CI 0.255-0.963). Subgroup analysis confirmed that patients with ISS II/III or non-ASCT achieved better PFS and OS in the surgical group (PFS: P = 0.033, P = 0.040; OS: P = 0.024, P = 0.018 respectively), while similar survival outcome was observed in patients with ISS I or ASCT between two groups.

Conclusion: For NDMM patients, not only does PVP/PKP alleviate bone pain, meanwhile, it improves the PFS and OS in advanced subpopulation or non-transplant myeloma patients, which suggests that shortening the gap from symptom onset to diagnosis by orthopedic surgery favors clinical prognosis.

Keywords: Kyphoplasty; Multiple myeloma; Orthopedic surgery; Prognosis; Vertebroplasty.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimates of progression-free survival and overall survival
Fig. 1
Fig. 1
Kaplan-Meier estimates of progression-free survival and overall survival
Fig. 2
Fig. 2
Kaplan-Meier estimates of progression-free survival and overall survival in the ISS II/III subgroup
Fig. 2
Fig. 2
Kaplan-Meier estimates of progression-free survival and overall survival in the ISS II/III subgroup
Fig. 3
Fig. 3
Kaplan-Meier estimates of progression-free survival and overall survival in the non-ASCT subgroup
Fig. 3
Fig. 3
Kaplan-Meier estimates of progression-free survival and overall survival in the non-ASCT subgroup
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