Solitary plasmacytomas

Abstract

BACKGROUND:The objective of this study was to review the outcome of patients with solitary plasmacytoma (SP) after definitive radiation therapy. METHODS: The authors retrospectively reviewed 84 patients with SP who were diagnosed and treated at The University of Texas MD Anderson Cancer Center during 1988 to 2008. The impact of tumor anatomic site, tumor size, and the presence of serum and urinary paraprotein at diagnosis was assessed on local control, survival, and the risk of developing multiple myeloma (MM). RESULTS: Fifty-nine patients (70%) had bone SP, and 25 patients (30%) had extramedullary SP. Serum paraprotein was present in 39 patients (46%). The median radiation dose was 45 grays (Gy) (range, 36-53.4 Gy). Local control was achieved in 77 patients (92%). Neither radiation dose nor tumor size predicted local control. The 5-year rate of progression to MM was 47% and was higher for patients with bone SP (56% vs 30% for extramedullary SP; P ¼ .021), and patients who had serum paraprotein detected at diagnosis (60% vs 39%; P ¼ .016). On univariate analysis, patients aged <60 years and men had higher rates of progression to MM, although the differences were not significant (P ¼ .048 and P ¼ .29, respectively). Multivariate analysis revealed that bone location and serum protein at diagnosis were associated statistically with progression to MM. The 5-year overall survival rate for the entire patient cohort was 78%, and no difference was observed between patients who had bone SP versus extramedullary SP (76% vs 85%, respectively; P ¼ .274). CONCLUSIONS: The current results indicated that definitive radiation therapy for SP can provide excellent local control. Progression to MM remains the main problem and is more common among patients with bone SP and those who have serum paraprotein detected at diagnosis. Cancer 2011;117:4468-

The multiple oral presentations of multiple myeloma

“…Malignant plasma cells may interact with the marrow stroma and an extensive cytokine network resulting in osteolytic destruction of bone, or in some cases, producing extramedullary expansion or soft tissue plasmacytomas. In the absence of additional lesions, and other features of a systemic plasma cell disorder, fewer than 5% of patients with a plasma cell dyscrasia will be diagnosed with a solitary bone or extramedullary plasmacytoma [4,5] It is important to distinguish these patients from counterparts with myeloma since approximately 35–65% of these patients may be curable with definitive radiotherapy [5]…”

Role of Radiotherapy in Multiple Myeloma; A Multicentric Experience.

“…Balducci et al (2011) described re-calcification in patients with osteolytic lesions due to diverse plasma cell neoplasm in 50% and identified as complete remission in 38%. Mose et al (2000) also found a relevant effect in concurrent chemotherapy, but no difference in re-calcification in terms of radiation dose probably due to the low variability in total doses (30)(31)(32)(33)(34)(35)(36). In summary, available data indicate that higher radiation doses result in improved re-calcification.…”

Multiple myeloma with intracranial extension and bilateral renal infiltration: A case report and review of the literature

“…However, previous studies indicated that a combination treatment may provide the best results (7). The majority of EMPs involve the head and neck regions (8), although different anatomical sites, including the gastrointestinal tract, central nervous system, thyroid gland and breast may also be affected (7). However, it is rare that EMPs present initially with simultaneous intracranial and renal infiltration.…”