Clinical and prognostic features of plasmacytomas: A multicenter study of Turkish Oncology Group‐Sarcoma Working Party

Kılçıksız, Sevil; Çelik, Ö. Karakoyun; Pak, Yücel; Demiral, Ayşe Nur; Pehlıvan, Mustafa; Orhan, Okan; Tokatli, Füsun; Ağaoğlu, Fulya Yaman; Zincircioglu, Burhanedtin; Atasoy, Beste Melek; Ozseker, Naciye; Yersal, Özlem; Niang, Umar; Haydaroğlu, Ayfer

doi:10.1002/ajh.21211

Cited by 59 publications

(61 citation statements)

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“…The median TTP in this cohort was 49 months (18 months in those who progressed), and this along with the overall proportion of patients progressing is broadly comparable with previous series. [3][4][5][6][7][8][9][10] Progression was documented in 72% (26/34) of patients with OMD compared with 12.5% (2/16) without, and the median TTP was 26 months vs not reached (NR) (P 5 .003; Figure 1A). In a similar analysis, Warsame et al have demonstrated that the presence of clonal plasma cells (as determined by trephine biopsy immunohistochemistry), but below the 10% threshold for the diagnosis of myeloma, was associated with progression.…”

Section: Resultsmentioning

confidence: 99%

“…The overall incidence of progression is 37% to 72%, with median reported times to progression (TTP) of 2 years or less. [3][4][5][6][7][8][9][10] We hypothesized that progression in SPB might occur as a result of occult disease outside of the irradiation field. To further evaluate this, we used multiparameter flow cytometry (MFC) to assess staging bone marrow (BM) samples for the presence of occult disease and determine its impact on outcome.…”

Section: Introductionmentioning

confidence: 99%

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Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis

Hill

Rawstron

Tute

et al. 2014

Blood

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Key Points• Occult marrow disease is demonstrable in 68% of patients with solitary plasmacytoma of bone and is predictive of progression.• Trials of adjuvant systemic therapy are warranted in high-risk patients.The purpose of this study was to use multiparameter flow cytometry to detect occult marrow disease (OMD) in patients with solitary plasmacytoma of bone and assess its value in predicting outcome. Aberrant phenotype plasma cells were demonstrable in 34 of 50 (68%) patients and comprised a median of 0.52% of bone marrow leukocytes. With a median follow-up of 3.7 years, 28 of 50 patients have progressed with a median time to progression (TTP) of 18 months. Progression was documented in 72% of patients with OMD vs 12.5% without (median TTP, 26 months vs not reached; P 5 .003). Monoclonal urinary light chains (ULC) were similarly predictive of outcome because progression was documented in 91% vs 44% without (median TTP, 16 vs 82 months; P < .001). By using both parameters, it was possible to define patients with an excellent outcome (lacking both OMD and ULC, 7.7% progression) and high-risk patients (OMD and/or ULC, 75% progression; P 5 .001). Trials of systemic therapy are warranted in high-risk patients. (Blood. 2014;124(8):1296-1299 IntroductionSolitary plasmacytoma of bone (SPB) is characterized by localized areas of bone destruction by monoclonal plasma cells in the absence of clinical, laboratory, and radiologic features of multiple myeloma (MM). 1 Local irradiation remains the treatment of choice. United Kingdom national guidelines recommend doses of 40 to 50 Gy depending on tumor size, with a 2-cm margin, because this provides excellent local control.2 A significant proportion of patients will however progress with new lesions outside the irradiation field or, more typically, with generalized myeloma. The overall incidence of progression is 37% to 72%, with median reported times to progression (TTP) of 2 years or less. [3][4][5][6][7][8][9][10] We hypothesized that progression in SPB might occur as a result of occult disease outside of the irradiation field. To further evaluate this, we used multiparameter flow cytometry (MFC) to assess staging bone marrow (BM) samples for the presence of occult disease and determine its impact on outcome. Patients and methodsFifty patients (median age, 65years) with a histologically confirmed diagnosis of SPB according to International Myeloma Working Group (IMWG) criteria 1 were evaluated between 1998 and 2008. The solitary nature of the presenting lesion was confirmed by plain radiography in all patients, and 35 also had negative spinal magnetic resonance imaging results. Positron emission tomography (PET) scanning was not routinely performed. Thirty-five of 50 patients had a monoclonal protein (27 IgG, 7 IgA, and 1 light-chain only) with a median concentration of 7 g/L. Urine immunofixation demonstrated monoclonal urinary light chains (ULC) in 11 of 45 patients, but the serum-free light-chain (SFLC) assay was not routinely available. Patients were treated in two r...

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis

Hill

Rawstron

Tute

et al. 2014

Blood

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“…Due to its rarity, most of our knowledge derives from retrospective studies, which usually regard RT as the most effective therapy. After a moderate (40-50Gy) dose of radiation (Mendenhall et al, 1980;Mendenhall et al, 2003;Kilciksiz et al, 2008), a 5-year local control rate of 81-95% could be expected (Ozsahin et al, 2006;Sasaki et al, 2012;Suh et al, 2012). 5-year overall survival rate is reported to be 70-78% (Frassica et al, 1989;Reed et al, 2011;Suh et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…As they considered, close observation is preferred rather than adjuvant RT after R0 resection (Strojan et al, 2002). Interestingly, a research including 57 SBPs and 23 EMPs showed surgery+RT resulted in significantly longer PFS, compared with RT alone (median PFS 7.4 years vs 2.6 years) (Kilciksiz et al, 2008). But this conclusion should be interpreted in caution because EMP, which has a better prognosis intrinsically, is usually associated with a higher portion of excisional biopsy due to its derivation from soft tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, whether surgery plays a beneficial role is still controversial although there is a consensus on surgical intervention in the management of pathological fracture, release of neurological symptoms and surgical biopsy in SBP (Sundaresan et al, 1994;Soutar et al, 2004). Some researchers demonstrated that the addition of surgery contributes to enhancing local control and disease-free survival (DFS) as well (Ozsahin et al, 2006;Kilciksiz et al, 2008). However, in EMP, the effect of surgery is disputed.…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma

Li¹,

Niu²,

Wang³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. Materials and Methods: Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. Results: The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041). Conclusions: Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.

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Solitary plasmacytoma: Is radiation therapy sufficient?

Kumar

2008

American J Hematol

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Clinical and prognostic features of plasmacytomas: A multicenter study of Turkish Oncology Group‐Sarcoma Working Party

Cited by 59 publications

References 40 publications

Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis

Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis

Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma

Solitary plasmacytoma: Is radiation therapy sufficient?

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