Clinical features and treatment of newly diagnosed multiple myeloma with secondary myelofibrosis: a retrospective study.

Background: Secondary myelofibrosis (SMF) is characterized by the excessive deposition of fibrous tissue on top of the primary disease, often causing clinical manifestations to be overshadowed by the primary disease. Unfortunately, current staging systems do not incorporate myelofibrosis, leading to potential treatment delays for SMF.

Objectives: To evaluate the prognosis of patients with multiple myeloma (MM) complicated with myelofibrosis.

Design: The study included the clinical data and treatment results of 208 newly diagnosed multiple myeloma (NDMM) patients who were treated in the Affiliated Hospital of Qingdao University from January 2014 to August 2020, and performed a retrospective analysis.

Methods: All patients underwent bone marrow biopsy, and MF severity was classified into grades 0-3 according to the 2016 WHO criteria. Treatment efficacy was evaluated based on the International Myeloma Working Group (IMWG) standard and SPSS was used for analysis.

Results: The MM patients without SMF exhibited better treatment response (p < 0.05). Importantly, increasing degrees of myelofibrosis were associated with a significant reduction in median progression-free survival (PFS; p < 0.05). MM-SMF patients exhibited significantly shorter median PFS and overall survival (OS; p < 0.05). In the MM-SMF group, neutrophil-lymphocyte ratio >2.39, monocyte-lymphocyte ratio ⩽0.18, and platelet-lymphocyte ratio ⩽61.6 were associated with significantly reduced median PFS and OS (p < 0.05). Notably, the use of bortezomib-based regimens did not significantly impact prognosis in MM-SMF patients, while lenalidomide-based regimens significantly extended median OS but did not significantly affect median PFS.

Conclusion: Myelofibrosis emerges as an important prognostic indicator for predicting the survival outcomes of NDMM patients. In the era of new therapeutics, there is a pressing need to explore novel treatment strategies in order to improve the prognosis of patients with multiple myeloma complicated by myelofibrosis.