Solitary plasmacytoma of bone and asymptomatic multiple myeloma

Abstract

Most patients with multiple myeloma (MM) present with symptoms, have evidence of generalized disease, and require chemotherapy promptly to reduce the malignant clone. Some patients present with a local symptom from a single plasmacytoma but no myeloma elsewhere. Such patients usually become free of symptoms after local radiotherapy. In patients with MM without symptoms, the diagnosis is made on the basis of screening laboratory tests. In patients with either solitary plasmacytoma of bone or asymptomatic MM, systemic treatment should be deferred until there is evidence of disease progression.

Smoldering multiple myeloma: natural history and recognition of an evolving type

“…Despite the stringent criteria employed in our study, the time to progression was similar (median of about 3 years) to that observed in other studies that included patients with a lower tumour burden (Alexanian et al, 1988, Wisloff et al, 1991, Hjorth et al, 1993, Dimopoulos et al, 1993, 2000, Facon et al, 1995, Weber et al, 1997. In our series, the only significant predictor for an earlier progression was the type of SMM (evolving versus non-evolving).…”

“…This is in contrast with the findings of Wisloff et al (1991) who found that six and three of their 71 patients developed renal insufficiency or neurological symptoms respectively, at the time of progression. In the remaining series, the pattern of progression consisted of increasing bone disease, increasing M-protein or development of anaemia, with only occasional cases developing renal failure or hypercalcaemia (Alexanian et al, 1988, Hjorth et al, 1993, Dimopoulos et al, 1993, 2000, Facon et al, 1995, Weber et al, 1997. The fact that SMM patients do not develop renal insufficiency during the asymptomatic phase or at progression indicates the lack of nephrotoxic potential of their light chains.…”

“…The first six patients with recognized SMM remained in a stable condition with no chemotherapy requirement for many years. Since then, several series of patients with asymptomatic disease, referred to as asymptomatic or low tumour mass myeloma, have been reported (Alexanian et al, 1988, Wisloff et al, 1991, Hjorth et al, 1993, Dimopoulos et al, 1993, 2000, Facon et al, 1995, Weber et al, 1997 with particular emphasis on predictive factors for disease progression. However, the diagnostic criteria in the above studies were different from those of the original report (Kyle & Greipp, 1980).…”

“…In contrast with the original report, most of the above series included some patients with lytic bone lesions (Alexanian et al, 1988, Wisloff et al, 1991, Hjorth et al, 1993, Dimopoulos et al, 1993, Facon et al, 1995. As the presence of lytic lesions is consistently associated with a short time to progression (Alexanian et al, 1988, Wisloff et al, 1991, Dimopoulos et al, 2000, patients with lytic bone disease should be considered as having indolent rather than smoldering disease. In the current study, only those patients that fulfilled the stringent criteria originally reported (Kyle & Greipp, 1980) have been included.…”

“…These patients had stable disease not requiring chemotherapy for five or more years. Several series of patients with asymptomatic (Alexanian et al, 1988, Wisloff et al, 1991, Hjorth et al, 1993, Dimopoulos et al, 1993, 2000, Weber et al, 1997 or low tumour burden (Facon et al, 1995) myeloma have been reported. However, there are no reports that analysed the natural history of patients with SMM fulfilling the stringent criteria defined by Kyle and Greipp (1980).…”