High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall

Das-Gupta, EP; Sidra, G M; Bessell, EM; Lush, RJ; Byrne, J L; Russell, Nigel H.

doi:10.1038/sj.bmt.1704221

Cited by 3 publications

(4 citation statements)

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“…SP has been reported to be highly radiosensitive and chemosensitive [5,6,8]. However, as seen in our case and in the other reports [4,9], the prognosis and the sensitivity of SP to radiochemotherapy may be poor, and the course of the disease may be very aggressive.…”

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confidence: 60%

Extramedullary Plasmacytoma Involving the Abdominal Vessels and Pancreas

et al. 2007

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We read with great interest the article by Attwell and colleagues [1] in a recent issue of Digestive Diseases and Sciences that described a case of IgA multiple myeloma (MM) involving two unusual extramedullary sites: the porta hepatis and peritoneum. The involvement of abdominal vessels and pancreas by plasma cell neoplasms is very rare and usually diagnosed at autopsy [1][2][3]. We would like to describe and share our experience in a patient with known MM who developed plasmacytoma on the chest wall and in the abdomen involving the abdominal vessels and pancreas, without concurrent relapse of the disease, and to add some points concerning the treatment of extramedullary plasmacytomas (EMP).A 64-year-old-man was diagnosed to have stage II MM of the IgA(λ) subtype in 2001. He was given a chemotherapy regimen with six courses of melphalan and prednisolone and achieved a plateau phase. In 2002, at the sixth month of the plateau phase, the patient developed a painless mass in the right posterior-inferior region of the thorax. Chest computed tomography (CT) demonstrated a heterogeneously enhanced mass without destruction of the ribs in the chest wall with dimensions of 14 × 9 × 6 cm. Abdominal CT was normal. Bone marrow examination showed no relapse of MM. The results of a radiographic survey did not show an additional lesion. The patient was scheduled for a chest wall mass resection and reconstructive surgery. The operative course was uneventful. The excised chest wall tumor measured 14 × 12 × 4.5 cm. Examination of the permanent section revealed that the chest wall tumor was an IgA(λ)-type plasmacytoma. Six courses of melphalan-prednisolone were given and thalidomide therapy was started. The patient continued on routine controls and remained in plateau phase during follow-up, and the chest wall tumor did not show recurrence.In 2004, 18 months after resection of the chest wall plasmacytoma, he was readmitted to hospital with complaints of masses and jaundice lasting for 3 weeks. One of the masses was located below the surgical resection site and the other was on the right upper quadrant, extending through the epigastric region. Laboratory data were as follows: aspartate aminotransferase (AST), 87 U/L (normal range, 0-40); alanine aminotransferase (ALT), 135 U/L (normal range, 0-43); alkaline phosphatase, 129 U/L (normal range, 37-147); total bilirubin, 3.1 mg/dl (normal range, 0-1.1); direct bilirubin, 2.5 mg/dl (upper limit, 0.4); lactate dehydrogenase, 306 U/L (normal range, 125-243); total protein, 6.8 g/dl; albumin, 3.8 g/dl; creatinine, 1.1 mg/dl; uric acid, 3.8 mg/dl; calcium, 9.2 mg/dl; IgA, 85.8 mg/dl (normal range, 70-400); IgG, 1280 (normal range, 700-1600); and IgM, 16.8 mg/dl (normal range, 40-230). Bone marrow aspiration and biopsy and serum protein electrophoresis demonstrated normal findings. Chest CT revealed a mass with destruction of the 10th and 11th ribs in the right chest wall with Springer

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confidence: 60%

Extramedullary Plasmacytoma Involving the Abdominal Vessels and Pancreas

et al. 2007

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“…Therapeutic strategies for solitary plasmacytoma and EMP include surgery, chemotherapy, radiotherapy, along with combined approaches 2 . Although it was showed that solitary plasmacytoma are highly chemoradiosensitive 3,21,22 , many cases of EMP are reported to be insensitive to radiotherapy and chemotherapy 2,19,23 . In eligible patients, radiation therapy in the dose of 40-50 Gy has been suggested providing an excellent locoregional disease control 24 .…”

Section: Fig 5 -A B) the Tumor Forms A Submucosal Duodenal Nodule Wmentioning

confidence: 99%

Solitary extramedullary plasmacytoma of the duodenum and pancreas: A case report and review of the literature

2016

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“…Eight patients (67%) had received radiotherapy before the progenitor cell mobilisation. All patients except one had received previous chemotherapy for a median of four courses (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The most commonly applied regimen was VAD (10 patients).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Other high-risk features observed include nonsecretory PC (6), large PC (7) and persistence of paraprotein after the first line therapy (8). Limited data on ASCT in patients with PC is currently available (9,10). We have therefore evaluated the feasibility and potential efficacy of this approach in patients with high-risk PC who received ASCT in five Finnish transplant centres.…”

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confidence: 99%

Autologous stem cell transplantation in patients with high‐risk plasmacytoma

Jantunen

Koivunen

Putkonen

et al. 2005

European J of Haematology

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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.

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High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall

Cited by 3 publications

References 10 publications

Extramedullary Plasmacytoma Involving the Abdominal Vessels and Pancreas

Extramedullary Plasmacytoma Involving the Abdominal Vessels and Pancreas

Solitary extramedullary plasmacytoma of the duodenum and pancreas: A case report and review of the literature

Autologous stem cell transplantation in patients with high‐risk plasmacytoma

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