Improved Outcome in Solitary Bone Plasmacytomata With Combined Therapy

Abstract

Solitary bone plasmacytoma (SBP) is a rare presentation of plasma cell dyscrasias. Radiotherapy has been considered the treatment of choice, however, most patients will develop multiple myeloma, 3 to 10 years after initial diagnosis and treatment. No innovations have been introduced in the treatment of SBP in the last 30 years. We began a prospective clinical trial to assess the efficacy and toxicity of adjuvant chemotherapy with low doses of melphalan and prednisone administered to patients with SBP after radiation therapy in an attempt to improve the disease-free survival and overall survival. Between 1982 and 1989, 53 patients with SBP were randomly assigned to be treated with either local radiotherapy with doses ranged from 4000 to 5000 cGy to achieve local control of disease (28 patients) or the same radiotherapy schedule followed by melphalan and prednisone given every 6 weeks for 3 years (25 patients). After a median follow-up of 8.9 years, disease-free survival and overall survival were improved in patients who were treated with combined therapy, 22 patients remain alive and free of disease in the combined treatment group compared to only 13 patients in the radiotherapy group (p < 0.01). Treatment was well tolerated; planned doses were administered in all cases; no delays in treatment or acute side-effects were observed during treatment. Long-term secondary toxicities including secondary neoplasms and acute leukaemia, have not been observed. We felt that the use of adjuvant chemotherapy after adequate doses of radiotherapy in patients with SBP improved duration of remission and survival without severe side-effects. However, as with other studies in SBP, the group was too small to draw definitive conclusions and more controlled clinical trials are necessary to define the role of this therapeutic approach in patients with SBP.

Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA

“…There has been only one relevant prospective trial thus far, and it evaluated the benefit of chemo radiotherapy in 53 patients. Although the study included a limited number of patients, it concluded that combination therapy increased survival duration as well as remission [30]. Kumar et al presented in a series of 25 SBP patients that angiogenesis was highly associated with disease progression to myeloma [31].…”

Clinical features, outcome, and prognostic factors for survival and evolution to multiple myeloma of solitary plasmacytomas: A report of the Greek myeloma study group in 97 patients

“…According to the current guidelines, additional C/T is not generally recommended unless there is suboptimal response to R/T, relapse, or progression to MM . However, patients with large masses and high‐grade histology may have some benefit from the additional use of C/T, as supported in previous studies . In the past decade, there have been major advances in the treatment of MM.…”

“…The role of adjuvant chemotherapy (C/T) in the treatment of SP was explored in several published studies with inconclusive results . According to the current guidelines, additional C/T is not generally recommended unless there is suboptimal response to R/T, relapse, or progression to MM .…”

Primary plasmacytoma of the cranial vault: a case report

“…It is characterized by a decrease in the amount of beta-lymphocytes and the mean age of the patients is 60 years [1]. Plasmacytoma is a myelomatous mass that may be solitary, in combination with multiple myeloma or may progress to a generalized disease [7-9].…”

“…Plasmacytomas are referred to benign lesions that may progress to multiple myeloma, a fatal neoplasm [1]. Skull plasmacytomas are unusual tumors accounting for 4% of all plasma cell tumors [1-6]. We report on a rare case of a skull plasmacytoma in a patient with active tuberculosis and no evidence of multiple myeloma that was successfully treated by surgery alone.…”