Extramedullary (EMP) relapse in unusual locations in multiple myeloma: Is there an association with precedent thalidomide administration and a correlation of special biological features with treatment and outcome?

Katodritou, Eirini; Gastari, Vassiliki; Verrou, Evgenia; Hadjiaggelidou, Christina; Varthaliti, Maria; Georgiadou, Sofia; Laschos, Kostas; Xirou, Persefoni; Yiannaki, E.; Constantinou, N.; Markala, Dimitra; Zervas, Kostas

doi:10.1016/j.leukres.2009.01.036

Cited by 47 publications

(37 citation statements)

References 11 publications

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“…17,19 In addition, survival following an EMM relapse reportedly varies between 4-30 months. [20][21][22] In the current case, the patient responded poorly to treatment, developed new lesions at multiple sites and survived for only eight months following the diagnosis. Similar findings have been noted in previous reports.…”

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confidence: 59%

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Relapse of Multiple Myeloma Presenting as Lower Lip Numbness

Al-Riyami

Bakathir

Al-Farsi

et al. 2016

SQUMJ

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confidence: 59%

“…Similar findings have been noted in previous reports. 18,[20][21][22] As such, a high index of suspicion is needed when treating patients with a previous history of MM, even during remission.…”

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confidence: 99%

Relapse of Multiple Myeloma Presenting as Lower Lip Numbness

Al-Riyami

Bakathir

Al-Farsi

et al. 2016

SQUMJ

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“…Three of 4 previously reported cases were also treated with novel agents and/or stem cell transplantation prior to the EMP relapse in the scar tissue. It has been suggested that both thalidomide [10,11] and HSCT (autologous or allogeneic) [12] are associated with extramedullary relapse. As previously suggested, prolongation of life by these agents, allowing for myeloma subclones with a predilection for extramedullary sites to develop and become clinically apparent, might in itself cause EMP progression [2].…”

Section: Discussionmentioning

confidence: 99%

Myeloma in Scar Tissue - An Underreported Phenomenon or an Emerging Entity in the Novel Agents' Era? A Single Center Series

et al. 2014

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Tumor relapse in scar tissue is uncommon in cancer patients. Likewise, extramedullary plasmacytoma (EMP) relapse in scar tissue in the setting of multiple myeloma (MM) has been rarely reported. We report a series of 3 patients whose disease progressed as EMP at the site of a wound from previous invasive procedures. All 3 patients were treated for the relapsed disease with different treatment modalities, but failed to respond adequately and died several months after relapse. At original MM diagnosis, all had advanced-stage disease. They were treated with novel agents with or without autologous hematopoietic stem cell transplantation and achieved either a complete or very good partial response. We suggest that these treatments, which have become the standard of care in MM, may permit a predominance of myeloma subclones which are independent of the bone marrow microenvironment. These myeloma subclones then gain a survival advantage in the active scar-tissue niche, allowing for their uncontrolled proliferation. This case series might represent an underreported phenomenon and therefore may indicate an emerging and difficult-to-treat disease in the era of targeted therapies in MM. Physicians treating MM should be aware of this phenomenon, especially when referring their patients for invasive procedures.

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“…10 ). The above mentioned adverse factors lead to resistance to treatment 11,12 . Clinically, three types of extramedullary lesions can be described: a) tumor mass adjacent to the bone and extending into soft tissues, b) soft tissue or visceral tumor that is not connected to the bone or c) diffuse infiltration of organs by PC without any obvious focal lesion 3 .…”

Section: Introductionmentioning

confidence: 99%

Extramedullary relapse of multiple myeloma defined as the highest risk group based on deregulated gene expression data

Ševčı́ková¹,

Paszekova

Bešše³

et al. 2015

BIOMED PAP

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Background. Multiple myeloma (MM) is characterized by malignant proliferation of plasma cells (PC) which accumulate in the bone marrow (BM). The advent of new drugs has changed the course of the disease from incurable to treatable, but most patients eventually relapse. One group of MM patients (10-15%) is considered high-risk because they relapse within 24 months. Recently, extramedullary relapse of MM (EM) has been observed more frequently. Due to its aggressivity and shorter survival, EM is also considered high-risk. Aims. The goal of this study was to determine if the so-called high-risk genes published by the University of Arkansas group (UAMS) are even more deregulated in EM patients than in high-risk MM patients and if these patients may be considered high-risk. Methods. Nine samples of bone marrow plasma cells from MM patients as well as 9 tumors and 9 bone marrow plasma cells from EM patients were used. Quantitative real-time PCR was used for evaluation of expression of 15 genes connected to the high-risk signature of MM patients. Results. Comparison of high-risk plasma cells vs extramedullary plasma cells revealed 4 significantly deregulated genes (CKS1B, CTBS, NADK, YWHAZ); moreover, comparison of extramedullary plasma cells vs extramedullary tumors revealed significant differences in 9 out of 15 genes. Of these, 6 showed significant changes as described by the UAMS group (ASPM, SLC19A1, NADK, TBRG4, TMPO and LARS2). Conclusions. Our data suggest that increasing genetic abnormalities as described by the gene expression data are associated with increased risk for EM relapse.

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Extramedullary (EMP) relapse in unusual locations in multiple myeloma: Is there an association with precedent thalidomide administration and a correlation of special biological features with treatment and outcome?

Cited by 47 publications

References 11 publications

Relapse of Multiple Myeloma Presenting as Lower Lip Numbness

Relapse of Multiple Myeloma Presenting as Lower Lip Numbness

Myeloma in Scar Tissue - An Underreported Phenomenon or an Emerging Entity in the Novel Agents' Era? A Single Center Series

Extramedullary relapse of multiple myeloma defined as the highest risk group based on deregulated gene expression data

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