Refractory Plasmablastic Type Myeloma with Multiple Extramedullary Plasmacytomas and Massive Myelomatous Effusion: Remarkable Response with a Combination of Thalidomide and Dexamethasone

Nakazato, Tomonori; Suzuki, Kazuhito; Mihara, Ai; Yukitoshi, Sanada; Kakimoto, Tsunayuki

doi:10.2169/internalmedicine.48.2142

Cited by 20 publications

(15 citation statements)

References 22 publications

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“…36 However, other case reports found thalidomide combined with dexamethasone or alkylating agents to be effective in both IM and EM PCM. 37,38 Biagi and Prince 39 reported three PCM patients with EM relapse after allogeneic HCT responded to thalidomide. The response to thalidomide was postulated to be more due to the augmentation of GVM effects than antitumor effects.…”

Section: Chemotherapymentioning

confidence: 99%

Extramedullary disease in plasma cell myeloma: the iceberg phenomenon

Wirk

Wingard

Moreb

2012

Bone Marrow Transplant

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Section: Chemotherapymentioning

confidence: 99%

Extramedullary disease in plasma cell myeloma: the iceberg phenomenon

Wirk

Wingard

Moreb

2012

Bone Marrow Transplant

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“…[7,8] Extramedullary plasmacytomas have been reported in 15-20% of patients at diagnosis and in an additional 15% during the course of PCM, and these patients are often associated with highrisk diseases like myelomatous pleural effusion (MPE). [9] Extramedullary existence of plasmacytoma is not common and the incidence of thoracic cases is low, especially in patients presenting with pulmonary plasmacytoma and malign pleural efusion to simulate a pleural mesothelioma or lung cancer. [6,10] We report here a unique presentation of PCM to include monoclonal components and lung plasmacytoma as initially mistaken for metastatic lung cancer.…”

Section: Discussionmentioning

confidence: 99%

Multiple myeloma mimicking metastatic lung cancer

Furuncuoglu¹,

Cirak²,

Türk³

et al. 2015

TJ Oncol

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Multiple myeloma is a hematological malignancy characterized by a clonal proliferation of plasma cells in the bone marrow. Extramedullary dissemination of multiple myeloma is uncommon. Only in rare cases, the malignant plasma cells of multiple myeloma had infiltrated the lung parenchyma. In this case report, we presented a case of multiple myeloma with lung plasmacytoma, in a 42-year-old patient, hospitalized for pain and infiltrative mass in the right lung. The results of his initial evaluation with computed tomography and positron emission tomograpy scanning, resembled lung tumor with bone metastasis. Surprisingly, biopsies from lung tumor and bone metastasis, revealed malignant plasma cells. We found M spike in protein electrophoresis and lambda monoclonal band in immune electrophoresis. A bone marrow biopsy evaluation was done and justified multiple myeloma diagnosis before hematology referral. Multiple myeloma diagnosis at the age of 42 is quite rare.Keywords: Cancer; lung; metastasis; myeloma.Multipl miyelom kemik iliğinde plasma hücrelerinin klonal proliferasyonu ile karekterize hematolojik malign bir hastalıktır. Multipl miyelomda ekstramedüller yayılım sık değildir. Çok nadir olgularda multipl miyelom nedenli plazma hücrele-ri akciğer parankimini infiltre eder. Bu yazıda, sağ akciğerde infiltratif kitle ve ağrı nedeniyle hastaneye yatırılan, akciğer plasmasitomlu multipl miyelomu olan 42 yaşında bir hasta sunuldu. Bilgisayarlı tomografi ve pozitron emisyon tomografisi ile yapılan ilk değerlendirmede kemik metastası olan akciğer tümörüne benzetildi. Akciğerdeki tümörden ve kemikteki metastastan yapılan biyopside sürpriz olarak malign plazma hücreleri görüldü. Protein elektroforezinde M spike ve immün elektroforezde monoklonal lamda bandı bulundu. Kemik iliği biyopsisi yapıldı ve multipl miyelom tanısı konarak hematolojiye refere edildi. Multipl miyelom 42 yaşında nadir görülür.

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“…7,8 In addition, a synergistic effect with dexamethasone has also been reported. 9 Thalidomide reportedly has an antiangiogenic effect and exerts its antitumor effect by changing the microenvironment of the bone marrow in the presence of stromal cells. 10 Therefore, thalidomide is considered to be poorly effective for extramedullary masses.…”

Section: Discussionmentioning

confidence: 99%

A Case of Extramedullary Plasmablastic Plasmacytoma Successfully Treated Using a Combination of Thalidomide and Dexamethasone and a Review of the Medical Literature

Sekiguchi

Asahina

Shimada³

et al. 2013

J Clin Exp Hematopathol

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A 56-year-old man developed epistaxis, hoarseness, and swelling of a finger in March 2010. On the basis of biopsies of the masses in the pharynx and finger, he was diagnosed with extramedullary plasmablastic plasmacytoma, with somewhat immature CD45 + , MPC-1 − , and CD49e −. CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and VCAP (vincristine, cyclophosphamide, doxorubicin, and prednisolone) therapy was ineffective, but combination therapy with thalidomide and dexamethasone was highly effective. Thalidomide monotherapy successfully maintained partial remission for approximately 7 months. A mass appeared in the right neck in February 2011, and a biopsy confirmed recurrence. Changes to CD45 negativity and MPC-1 partial positivity were seen, while CD49e negativity persisted, suggesting that the plasmablastic plasmacytoma had reverted to a more immature state. Bortezomib therapy was started in March 2011 and was effective. However, during the second round of treatment, the patient developed acute lung injury, which was improved by steroid pulse therapy. After the discontinuation of bortezomib, the extramedullary mass increased rapidly, and the patient died of multiple organ failure. An autopsy showed that plasmablastic plasmacytomas had infiltrated into multiple organs. Extramedullary plasmacytomas and those that revert to an immature state are associated with a poor prognosis, so further treatment improvements are needed in the future. 〔J Clin Exp Hematop 53(1): 21-28, 2013〕

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Refractory Plasmablastic Type Myeloma with Multiple Extramedullary Plasmacytomas and Massive Myelomatous Effusion: Remarkable Response with a Combination of Thalidomide and Dexamethasone

Abstract: A 74-year-old

Cited by 20 publications

References 22 publications

Extramedullary disease in plasma cell myeloma: the iceberg phenomenon

Extramedullary disease in plasma cell myeloma: the iceberg phenomenon

Multiple myeloma mimicking metastatic lung cancer

A Case of Extramedullary Plasmablastic Plasmacytoma Successfully Treated Using a Combination of Thalidomide and Dexamethasone and a Review of the Medical Literature

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