Bone disease burden does not impact overall survival in newly diagnosed patients with multiple myeloma - a single center, retrospective imaging analysis on 119 patients.

Background: Multiple myeloma (MM) frequently presents with myeloma bone disease (MBD), manifesting as osteolytic lesions and skeletal-related events (SREs), significantly impairing quality of life and increasing morbidity. Whole-body low-dose computed tomography (WBLDCT) has become the standard for assessing bone involvement at diagnosis, but its prognostic significance remains unclear. The aim of this study was to evaluate the burden of MBD in newly diagnosed MM patients using WBLDCT and examined associations between imaging characteristics and survival outcomes. Methods: In this retrospective, single center, analysis of 119 MM patients, WBLDCT was performed at diagnosis prior to treatment initiation. Imaging findings, including vertebral compression fractures (VCFs), lesion number, cortical destruction, and appendicular skeleton medullary cavity (ASMC) patterns, were recorded. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox regression models. Results: VCFs were significantly associated with inferior PFS (18.1 vs. 33.6 months; p = 0.013) and OS (51.5 months vs. not reached; p = 0.023) in univariate analyses. However, in multivariable models, no imaging parameter, including VCFs, retained independent prognostic significance. Other imaging variables (lesion count, ASMC subtype, cortical destruction) were not predictive of outcomes. Conclusions: While VCFs identified on WBLDCT correlate with poor outcomes in univariate analysis, they do not serve as independent prognostic markers when adjusting for established clinical factors. These findings suggest that in the era of novel anti-myeloma therapeutics, the bone disease burden at diagnosis may not impact prognosis significantly.