How We Manage Patients with Plasmacytomas
Purpose of Review
To discuss the diagnostic approach, treatment options, and future considerations in the management of plasmacytomas, either solitary or in the context of overt multiple myeloma (MM).
Advanced imaging techniques such as whole-body magnetic resonance imaging and positron emission tomography/computerized tomography are essential for the diagnostic workup of solitary plasmacytomas (SP) to rule out the presence of other disease foci. The role of flow cytometry and clonal plasma cell detection is currently under study together with other prognostic factors for the identification of patients with SP at high risk of progression to overt MM. Solitary plasmacytomas are treated effectively with local radiotherapy whereas systemic therapy is required at relapse. Clonal plasma cells that accumulate at extramedullary sites have distinct biological characteristics. Patients with MM and soft tissue involvement have poor outcomes and should be treated as ultra-high risk.
A revised definition of SP that distinguishes between true solitary clonal PC accumulations and SP with minimal bone marrow involvement should be considered to guide an appropriate therapeutic and follow-up approach. Future studies should be conducted to determine optimum treatment approaches for patients with MM and paraskeletal or extramedullary disease.
KeywordsPlasma cells Tumor Solitary lesion Bone disease Extramedullary
Compliance with Ethical Standards
Conflict of Interest
Dr. Dimopoulos reports personal fees from Amgen, personal fees from Celgene, personal fees from Janssen, and personal fees from Takeda, during the conduct of the study. Dr. KASTRITIS reports personal fees from Amgen, personal fees from Genesis Pharma, personal fees from Janssen, personal fees from Takeda, and personal fees from Prothena, during the conduct of the study. Dr. Fotiou has nothing to disclose.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 15.Hill, Q.A., et al., Neoplastic plasma cells are demonstrable at bone marrow sites distant to solitary plasmacytoma of bone and predict for progression to multiple myeloma. ASH Annual Meeting Abstracts, 2006. 108(11): p. 3512-.Google Scholar
- 32.Zamagni E, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92(1):50–5.CrossRefPubMedGoogle Scholar
- 50.Weber, D.M., Solitary bone and extramedullary plasmacytoma. Hematology Am Soc Hematol Educ Program, 2005;373–6.Google Scholar
- 74.Moreau P, et al. Prospective evaluation of magnetic resonance imaging and [(18)F]Fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM Study. J Clin Oncol. 2017;35(25):2911–8.CrossRefPubMedGoogle Scholar
- 81.Paubelle E, et al. Complete remission with bortezomib on plasmocytomas in an end-stage patient with refractory multiple myeloma who failed all other therapies including hematopoietic stem cell transplantation: possible enhancement of graft-vs-tumor effect. Leukemia. 2005;19(9):1702–4.CrossRefPubMedGoogle Scholar
- 86.Sonneveld P, et al. Bortezomib-based versus nonbortezomib-based induction treatment before autologous stem-cell transplantation in patients with previously untreated multiple myeloma: a meta-analysis of phase III randomized, controlled trials. J Clin Oncol. 2013;31(26):3279–87.CrossRefPubMedGoogle Scholar
- 88.Durie BG, et al. Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomized, open-label, phase 3 trial. Lancet. 2017;389(10068):519–27.CrossRefPubMedGoogle Scholar