Autologous stem cell transplantation in patients with high‐risk plasmacytoma

Abstract

Although autologous stem cell transplantation (ASCT) is considered standard treatment in patients with multiple myeloma (MM), limited experience is available on this approach in patients with plasmacytoma (PC). Twelve patients with high-risk PC received ASCT in Finland 1994-2002. There were nine males and three females with a median age of 50 yr (32-64). Ten patients had a PC of bone, whereas two patients had extramedullary PCs. The median time from the diagnosis to ASCT was 9 months (5-100). At the time of ASCT six patients were in first complete remission (CR) or partial remission (PR), in four patients the disease was refractory to the first line therapy and two patients had relapsed. High-dose therapy consisted of melphalan (MEL)200 (n = 7), MEL200 x 2 (n = 3) or total body irradiation (TBI)-MEL140 (n = 2). No transplant-related deaths occurred. After ASCT eight patients (67%) were in CR, one patient in very good PR and one patient in PR; two patients were non-responders. With a median follow-up of 48 months from ASCT, 11 patients (92%) are alive. Six patients (50%) have relapsed or progressed 3-81 months from ASCT. ASCT is feasible in this patient population resulting in promising overall survival. A randomised trial is needed to assess the real value of ASCT when compared with other treatment options in patients with high-risk PC.

Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel

“…Conversely, other studies indicate that adjuvant chemotherapy for SP has no benefit [ 51 , 52 ]. Also, autologous stem cell transplantation has been evaluated in high-risk SP patients but, although the initial results were promising, the small number of patients in this study precludes drawing definitive conclusions [ 53 ]. Some of the authors of these guidelines propose the use of adjuvant chemotherapy for bulky SP (> 5 cm), but this approach is not supported by previous studies.…”

Solitary Bone and Extramedullary Plasmacytoma

“…[3][4][5] More recently, even myeloablative therapy with stem cell support has been evaluated in high-risk patients with solitary bone plasmacytoma, but results are too premature to draw any conclusions given the long natural history of this disease. 12 It is unclear whether the risk of early therapy for SBP may predispose to development of either resistant plasma cell clones or to secondary leukemia. Thus, given the lack of consistent data proving benefit from chemotherapy, we and others believe that there is no current role for adjuvant chemotherapy in the initial treatment of SBP.…”

Successful Autologous Hematopoietic Stem Cell Transplantation Followed by Bortezomib Maintenance in a Patient with Relapsed CD138-low Multiple Solitary Plasmacytomas Harboring a 17p Deletion

“…Radical radiotherapy with or without surgery is recommended for the treatment of SBP; however, an effective treatment strategy has not been established for patients with MSP ( 2 , 3 ). Autologous hematopoietic stem cell transplantation (auto-HSCT) was previously shown to be effective for improving overall survival in patients with high-risk plasmacytoma ( 4 ). Patients who were considered to be at high risk of evolution to multiple myeloma (MM) were included in the study; however, a risk classification based on a cytogenetic analysis was not used ( 4 ).…”

“…Autologous hematopoietic stem cell transplantation (auto-HSCT) was previously shown to be effective for improving overall survival in patients with high-risk plasmacytoma ( 4 ). Patients who were considered to be at high risk of evolution to multiple myeloma (MM) were included in the study; however, a risk classification based on a cytogenetic analysis was not used ( 4 ). Radiotherapy plus adjuvant chemotherapy and the use of novel-agents have not improved survival in patients with solitary plasmacytoma ( 5 ).…”