Quiz: Incidence of Extramedullary Disease in Multiple Myeloma

June 18, 2019

How much do you know about the incidence of extramedullary disease in patients with multiple myeloma? Take our latest quiz to test your knowledge.

In our June multiple myeloma quiz, you'll get a chance to test your knowledge of the incidence of extramedullary disease in multiple myeloma. Here's your first question:

1. Extramedullary multiple myeloma can affect which of the following?

A.Lymph nodes


C.Central nervous system

D.All of the above

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Answer: D. All of the above. Extramedullary disease can affect any tissue, including the lymph nodes, liver, skin, lungs, genitourinary tissues, breast, pancreas, and elsewhere. Approximately 1% of cases involve central nervous system tissue invasion.


2. Secondary genomic changes to multiple myeloma subclones that allow escape from the bone marrow into other organs include:

A. TP53 mutationsB. t(4;14) translocationC. del(13)D.All of the above

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Answer: D. All of the above. The available evidence base is small but suggests that secondary alterations in escaping subclones that cause extramedullary disease include more frequent TP53 mutations, t(4;14) and del(13).


3. By definition, extramedullary disease includes which of the following?

A.Tumors extending directly from bone lesions into soft tissueB.Plasma cell infiltration of soft tissues apart from bone-destroying lesionsC.Neither of the aboveD.Both A and B

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Answer: D. Both A and B. There are varying definitions of extramedullary multiple myeloma in the research literature. Primary extramedullary disease is detected at the time of diagnosis of multiple myeloma, while secondary extramedullary disease is detected at the time of multiple myeloma relapse. Some researchers define extramedullary disease as tumors that extend directly from osteolytic bone lesions, while some define it as a subvariant of extramedullary disease, called EM-B (bone related), differentiating it from the plasma cell infiltration of soft tissues, EM-S (soft tissue–related), that others have defined as extramedullary disease.


4. The International Myeloma Working Group (IMWG) recommends __________ at diagnosis of multiple myeloma to complement skeletal survey imaging and __________ to characterize extramedullary disease.

A.Whole-body MRI; whole-body CTB.Whole-body MRI; PET/CTC.Whole-body CT; whole-body MRID. Whole-body CT; PET/CT

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Answer: B. Whole-body MRI; PET/CT. While extramedullary multiple myeloma can be detected using a range of imaging modalities, including ultrasonography, CT, PET, PET/CT, and MRI, once widely used conventional x-ray imaging is insensitive and should be avoided. The IMWG has recommended whole-body MRI at diagnosis to complement skeletal survey findings with soft tissue imaging and to use PET/CT to characterize the extent of extramedullary disease.


5. Extramedullary multiple myeloma reportedly affects up to ____ of patients following allogeneic stem cell transplantation (allo-SCT).

A. 17%B. 27%

C. 37%

D. 47%

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Answer: C. 37%. Estimates vary, but extramedullary disease appears to affect between 6% and 20% of patients with multiple myeloma overall. In one study, up to 37% of those who had undergone allo-SCT were found to have extramedullary multiple myeloma.