Multiple cutaneous plasmacytomas following an autologous peripheral stem cell transplant

Ah-Weng, Allan; Charles‐Holmes, R.; Rose, Peter; Basu, Supratik; Marsden, Jerry; Sanders, D. S. A.

doi:10.1046/j.1365-2230.2002.01039.x

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Four out of seven patients in these cases died from rapid progression of the disease. Concurrent chemoradiation therapy is considered a treatment of choice in patients with extensive involvement7101213. We herein report an interesting case of cutaneous plasmacytoma at the surgical site of fracture repair.…”

Section: Discussionmentioning

confidence: 92%

“…Metastasis of tumor at surgical sites can occur by different mechanisms. It may be due to etiologic factors of local surgical site such as direct wound contamination and manipulation of tumor cells and systemic condition of the patient such as alteration in immune response713. A theory has been proposed to explain the immunologic process of plasmacytoma metastasis at wound sites after chemotherapy regimen.…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

Yoo

Kim

et al. 2017

Ann Dermatol

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Multiple myeloma (MM) can be defined as a malignancy with monoclonal plasma cell proliferation. A 66-year-old man presented with pruritic erythematous to purplish plaque grouped nodule with black pigmentations and purpura on the right forearm. The patient was diagnosed with MM about five years prior to the visit at our hospital. Erythematous plaque on his right arm grew rapidly in size over one month and appeared about seven months after the fracture surgery. Skin biopsy showed multiple plasma cell infiltration with monoclonality for lambda light chain, which was consistent with cutaneous plasmacytoma. The patient refused to be treated and died two months later. We herein report an interesting case of cutaneous plasmacytoma at the surgical site of fracture repair.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

Yoo

Kim

et al. 2017

Ann Dermatol

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“…Hence, the newer drugs are unable to overcome the impact of this aspect of disease biology and ultimately the condition becomes resistant to salvage chemotherapy [10]. The pathogenesis of eMM post-ASCT is uncertain but may involve re-seeding of myeloma cells (by infusion of stem cells contaminated with MM cells during harvesting) and metastasis of residual myeloma due to incomplete myeloablation [14]. …”

Section: Discussionmentioning

confidence: 99%

Extramedullary progression of multiple myeloma despite concomitant medullary response to multiple combination therapies and autologous transplant: a case report

et al. 2014

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IntroductionExtramedullary myeloma that occurs during the clinical course of multiple myeloma is rare but is an independent poor prognostic factor with mortality of 73% and median survival of 12 months despite aggressive therapies including novel agents. The clinicopathological aspects, biology and management of extramedullary myelomas are poorly understood. Our case highlights the pathobiological aspects of this important but rare entity, and the repercussions of modern therapies.Case presentationA 60-year-old Caucasian man initially presented with an anterior rib fracture. Subsequent workup revealed stage IIIB immunoglobulin G lambda multiple myeloma. A bone marrow biopsy showed sheets of plasma cells, harboring unfavorable cytogenetics including deletion of 17p and t(4;14). He achieved near complete remission and resolution of karyotypic abnormalities with three cycles of induction doxorubicin, thalidomide, and dexamethasone (clinical trial). This was followed by high-dose melphalan and autologous stem cell transplant. He relapsed 1 year later. His bone marrow at that time showed only a few scattered polyclonal plasma cells. He received three cycles of bortezomib and tanespimycin (clinical trial) and achieved very good partial response. He again relapsed 1 year later with multiple large peripheral soft tissue masses and lymph nodes. Biopsies of the peripheral lesions were consistent with extramedullary myeloma, but repeat bone marrow biopsy continued to show no evidence of intramedullary disease.ConclusionsThis is one of the few cases reported that illustrates the differential response of extramedullary compared to intramedullary myeloma to multiple standard combination therapies including novel therapeutics and transplant, resulting in a very short survival. Several mechanisms for intra-to-extra medullary migration and hence the differential treatment response have been hypothesized. Physicians should be aware of this problem during treatment with immunomodulatory drugs and proteasome inhibitors not only in relapsed but also in front-line setting. In such cases, there is a potential role for evolving targeted therapeutics as we continue to better understand the tumor biology.

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“…The transformation from primarily medullary to extramedullary myeloma involvement after autologous or allogenic SCT is common, suggesting selection of plasma cell with atypical homing, or localized disease not eradicated by the conditioning (6, 7). Localized relapse can happen even in absence of systemic progression (8–10). Risk factors to develop extramedullary plasmacytomas are younger age, male gender, Bence‐Jones myeloma, lambda light chain, advanced stage, extensive skeletal involvement, and non‐secretory myeloma (2, 3).…”

Section: Discussionmentioning

confidence: 99%

Extensive soft‐tissue involvement by plasmablastic myeloma arising from displaced humeral fractures

Larrea

Rosiñol

Cibeira

et al. 2010

European J of Haematology

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A 44-yr-old man with IgG-lambda multiple myeloma reached a complete response after induction chemotherapy and autologous stem cell transplantation and maintenance therapy with interferon α2b and prednisone 4 yr later, he presented an increase in the M-protein plus extramedullary myeloma involvement with sacrum and clivus plasmacytomas. Treatment with bortezomib, cyclophosphamide and dexamethasone plus local radiotherapy was initiated. The patient developed a bilateral humeral pathological fracture. Surgical osteosynthesis of both humeri was performed with no immediate complications. Two months later, he developed a prominent swelling in both deltoid areas with fever and high serum LDH levels. X-ray examination showed a displacement of bone fragments of both humeri. Humerus CT scan showed a bilateral fracture in proximal diaphysis with posterior displacement. A magnetic resonance of right scapular region revealed a very extensive infiltration originated in the humerus. A fine-needle punction showed a diffuse plasmablastic infiltration. This case illustrates an atypical presentation of extramedullary myeloma with extensive soft-tissue involvement, originated at the fractured lytic lesions, which was likely triggered by bone surgery. This direct mechanism of myeloma spread has been observed in experimental myeloma mouse models.

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Multiple cutaneous plasmacytomas following an autologous peripheral stem cell transplant

Cited by 9 publications

References 10 publications

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

Cutaneous Plasmacytoma: Metastasis of Multiple Myeloma at the Fracture Site

Extramedullary progression of multiple myeloma despite concomitant medullary response to multiple combination therapies and autologous transplant: a case report

Extensive soft‐tissue involvement by plasmablastic myeloma arising from displaced humeral fractures

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