Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma

Soutar, Richard; Lucraft, Helen; Jackson, Gregory L.; Reece, A. T.; Bird, Jenny; Low, Eric; Samson, Diana

doi:10.1016/j.clon.2004.02.007

Cited by 262 publications

(401 citation statements)

References 50 publications

(15 reference statements)

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“…We have taken an intermediate position and advise elective regional lymph node radiation therapy only for patients with the highest risk of cervical lymph node disease (oral cavity, oropharynx, and nasopharynx), consistent with the Guidelines Working Group of the United Kingdom Myeloma Forum. 26 Note that, although the majority of our patients did not receive elective lymph node radiation, we had no failures in these areas.…”

Section: Discussionmentioning

confidence: 92%

Solitary plasmacytomas

Reed

Shah

Medeiros

et al. 2011

Cancer

100

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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-

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Section: Discussionmentioning

confidence: 92%

Solitary plasmacytomas

Reed

Shah

Medeiros

et al. 2011

Cancer

100

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“…Both guidelines from the National Comprehensive Cancer Network (NCCN, version4. 2014) and British Society for Haematology placed RT as a priority for SP (Soutar et al, 2004). 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).…”

Section: Introductionmentioning

confidence: 99%

“…2014) and British Society for Haematology placed RT as a priority for SP (Soutar et al, 2004). 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).…”

Section: Introductionmentioning

confidence: 99%

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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“…1 More than half of patients with solitary plasmacytoma eventually develop multiple myeloma, despite therapy. 2 The bone lesions, anemia and history of plasmacytoma in this patient were suspicious for multiple myeloma; however, AML can also present with lytic bone lesions. 3 Bone marrow examination is essential in the evaluation of both multiple myeloma and AML.…”

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confidence: 67%

Everything Points to Myeloma

2015

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CASEA 45-year-old man with a history of solitary plasmacytoma of the left hip, managed with surgery and radiation therapy 5 years back, was found to have new lytic lesions in his skull, discovered on an annual skeletal survey and confirmed by a head CT (Fig. 1). The patient had no major complaints, an unremarkable physical exam, and a mild anemia (Hemoglobin = 12 mg/dL). Due to concern for progression to multiple myeloma, the patient underwent a bone marrow biopsy, which revealed decreased hematopoiesis and 32 % myeloblasts, without evidence of a plasma cell dyscrasia (Fig. 2). Thus, a diagnosis of acute myeloid leukemia (AML) was made and induction chemotherapy was initiated.Secondary malignancies, including AML, can occur in patients with plasma cell disorders and a history of radiation or chemotherapy, and are associated with a worse prognosis. 1 More than half of patients with solitary plasmacytoma eventually develop multiple myeloma, despite therapy. 2 The bone lesions, anemia and history of plasmacytoma in this patient were suspicious for multiple myeloma; however, AML can also present with lytic bone lesions. 3 Bone marrow examination is essential in the evaluation of both multiple myeloma and AML.

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Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma

Cited by 262 publications

References 50 publications

Solitary plasmacytomas

Solitary plasmacytomas

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

Everything Points to Myeloma

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