Curability of solitary bone plasmacytoma.

Dimopoulos, MA; Goldstein, Jeffrey; Fuller, Lillian M.; Delasalle, Kay; Alexanian, Raymond

doi:10.1200/jco.1992.10.4.587

Cited by 125 publications

(51 citation statements)

References 12 publications

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“…on May 12, 2018. by guest www.bloodjournal.org From Figure 1B). In contrast to previous studies, [3][4][5][6][7][8][9][10]15 age, sex, vertebral location, or the presence of an M protein at diagnosis or its persistence at 1 year post-irradiation did not predict progression. The value of OMD and ULC were retained in multivariate analysis (P 5 .041 and .009, respectively; Table 1).…”

Section: ) (B)contrasting

confidence: 99%

“…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%

“…Dimopoulos and colleagues reported that disappearance of the M protein at 1 year after irradiation predicted a favorable outcome. 3 Likewise, Dingli and colleagues demonstrated the prognostic significance of an abnormal SFLC ratio as well as the persistence of the M protein at .1 year and proposed a prognostic model based on both parameters. 4 The major limitation of these studies is the reliance on the 1-year M-protein assessment, and models providing for risk stratification at initial diagnosis are needed.…”

Section: ) (B)mentioning

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: ) (B)contrasting

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: ) (B)mentioning

confidence: 99%

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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“…The published data on solitary plasmacytoma of bone suggests a disease-free survival of over 40% at 5 years and median overall survival of over 10 years for similar lesions outside the setting of POEMS syndrome. 16 Significantly, however, the persistence of a relatively small tumour mass in these cases is generally not associated with substantial morbidity. Experience with systemic amyloidosis demonstrates that application of PBSCT may be associated with increased morbidity and mortality in the setting of pre-existing multisystem pathology.…”

Section: Discussionmentioning

confidence: 98%

Peripheral blood stem cell transplantation for POEMS syndrome

Peggs

Paneesha

Kottaridis

et al. 2002

Bone Marrow Transplant

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Summary:In common with other plasma cell dyscrasias in which a small tumour burden is associated with severe clinical symptoms (notably systemic AL amyloidosis) the possible benefits of dose intensification are yet to be fully explored in POEMS syndrome. One important issue is whether the toxicity of the procedure is significantly increased in this group. We report two The acronym POEMS aids recognition of the more common features of a rare multi-system disorder associated with an underlying plasma cell dyscrasia (polyneuropathy, organomegaly (hepatosplenomegaly, lymphadenopathy), endocrinopathy (diabetes mellitus, hypogonadism, hypothyroidism), monoclonal gammopathy and skin changes (most frequently hyperpigmentation)). 1,2 In only a minority of cases are all the criteria met. A constellation of other clinical manifestations may be present including peripheral oedema, ascites, pleural effusions, pulmonary hypertension, papilloedema, polycythaemia, thrombocytosis and fever. 3 Bone lesions are also common. Miralles et al 4 described 38 patients, of whom 36 had bone lesions. In 31 of these the lesions were sclerotic or mixed sclerotic/lytic rather than predominantly lytic. The pathophysiological basis of the polyneuropathy along with other features of the disorder remains unclear. There is only limited evidence to support a direct role of the monoclonal protein in the neuropathy, 5 but it remains apparent that a Correspondence: K Peggs,

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