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ASTRO 2023: Tailoring Palliative Radiotherapy for Multiple Myeloma

By: Joshua D. Madera, MD
Posted: Monday, October 9, 2023

For patients with multiple myeloma, the use of palliative radiotherapy may be a suitable treatment option that extends durable long-term disease control, according to the results of a study presented at the 2023 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 313). However, the extent of palliative radiotherapy should be individualized, given the increased risk of disease progression at treated sites in patients with a higher disease burden, explained Robert W. Gao, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues.

From 2015 to 2020, a total of 362 treated lesions from 239 patients were analyzed. All patients had a diagnosis of multiple myeloma and were treated with palliative radiotherapy. The number of high-risk cytogenetic abnormalities was measured to determine which patients had two (n = 25) or three (n = 4) abnormalities. Patients underwent regular follow-up imaging to monitor disease progression.

The study authors reported the most common sites targeted with radiotherapy included the spine (34.5%), the abdomen and pelvis (18.5%), and the lower extremities (14.6%). In addition, at the median follow-up of 4.3 years, a 7.8% and a 13.4% risk of local disease progression on a per-lesion basis were identified at 1 and 4 years, respectively. No correlation between cytogenetic abnormalities and local disease progression was identified.

Furthermore, a univariate analysis was performed and revealed significant factors including the number of treated lesions (hazard ratio [HR] = 1.38), female sex (HR = 1.94), and the level of lactate dehydrogenase at diagnosis (HR = 1.04). However, in a multivariate analysis, only the number of treated lesions was a significant factor. Moreover, having two or three high-risk cytogenetic abnormalities was not found to be significantly correlated with disease progression.

Disclosure: Dr. Gao reported no conflicts of interest.

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