Reduced-intensity conditioning allogeneic transplantation is associated with a high incidence of extramedullary relapses in multiple myeloma patients

Pérez-Simón, Josè Antonio; Sureda, Anna; Fernández‐Avilés, Francesc; Sampol, Antònia; Cabrera, José Rafael; Caballero, Dolores; Martino, Rodrigo; Petit, Joachim; Tomás, J F; Moraleda, José M.; Alegre, Adrián; Cañizo, C; Brunet, Salut; Rosiñol, Laura; Lahuerta, Juan José; Díez-Martín, José Luís; León, Ángel; García, A. Sebio; Vázquez, Lourdes; Sierra, Jorge; Miguel, Jesús F. San

doi:10.1038/sj.leu.2404085

Cited by 80 publications

(57 citation statements)

References 9 publications

(12 reference statements)

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“…This is lower than the incidence of 37% reported by Perez-Simon et al 3 which can be explained by the differences in patient populations studied. All our patients received the sequential autologous-allogeneic NMA SCT approach and none were progressive at the time of the allogeneic SCT.…”

Section: Discussioncontrasting

confidence: 53%

“…However, the association of chronic GVHD with EM relapse demonstrated by others could not be confirmed in our study. 3,15 Also, the hypothesis of relative resistance of EM disease to GVM effects is in contrast with the effect of DLI on EM relapse. In our patient group, two out of three patients with EM disease at relapse obtained CR to DLI.…”

Section: Discussionmentioning

confidence: 96%

“…However, no information was given on the treatment and outcome of these EM relapses. 3 Previous reports on the incidence of EM relapse are of MM patients who received an allogeneic MA SCT. Byrne et al 4 published a series of 18 MA-transplanted patients with a follow-up of 5.3 years of whom 7 relapsed.…”

Section: Introductionmentioning

confidence: 99%

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Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome

Minnema

Donk

Zweegman

et al. 2008

Bone Marrow Transplant

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Recent literature suggests that after non-myeloablative allogeneic (NMA) stem cell transplantation (SCT), the incidence of extramedullary (EM) relapse in multiple myeloma (MM) patients is increased and that these relapses have a poor prognosis. However, numbers on incidence and treatment outcome are scarce. We collected data from 54 relapsed MM patients from a total group of 172 treated with sequential autologous and allogeneic NMA SCT at seven transplantation centres. There were 43 (79.6%) systemic relapses, including 6 with concurrent EM localisation. Five patients had a local EM relapse only. Six patients relapsed with only bone involvement. Patients with deletion of chromosome 13 had a higher incidence of EM relapse (30.8 versus 5.6%, P ¼ 0.06). EM relapses were treated with donor lymphocyte infusion, radiotherapy, or chemotherapy, especially with novel agents. The response rate was 45.5%, which was not different when compared to patients without EM disease (54.1%). Overall survival and progression-free survival were not significantly different in patients with EM disease, when compared to those without EM disease. In conclusion, the incidence of relapse with EM disease following allogeneic NMA SCT was 20.4%. There was no negative impact of EM relapse on response rate, overall survival and progression-free survival.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 96%

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Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome

Minnema

Donk

Zweegman

et al. 2008

Bone Marrow Transplant

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“…In a series of 70 patients enrolled in a Spanish study, extramedullary involvement was documented in 10 out of the 27 patients at first relapse (37%). 27 Interestingly, the incidence of extramedullary relapses was higher in patients who had developed chronic GVHD. Importantly, these patients had no evidence of disease recurrence in the marrow at the time of relapse.…”

Section: Study Populationmentioning

confidence: 99%

Clinical impact of immunophenotypic remission after allogeneic hematopoietic cell transplantation in multiple myeloma

Giaccone

Brunello

Festuccia

et al. 2015

Bone Marrow Transplant

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Immunophenotypic remission (IR) is a strong prognostic factor in myeloma patients. The combination of IR and conventional CR was retrospectively evaluated in 66 patients after allografting. IR was defined as the absence of monoclonal plasma cells in BM aspirates by multiparameter flow cytometry. Conditioning was non-myeloablative in 55 patients; reduced-intensity in 10 and myeloablative in 1 patient. The allograft was given upfront in 35/66 (53%) patients. After a median follow-up of 7

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“…Patient is planned for high dose therapy and autologous stem cell transplantation. Extramedullary plasmacytoma (EMP) may be seen at the time of initial diagnosis (7-18 %) or during the course of MM (6-20 %) and can arise either as (1) a local growth from the underlying bone, (2) hematogenous spread and (3) from invasive surgical procedures or fractures [2][3][4][5]. Cutaneous EMPs (5-10 %) are seen most frequently on trunk and abdomen and manifests as erythematous to violaceous cutaneous or subcutaneous papules, plaques or nodules with no evidence of lytic bone lesion directly below [6].…”

mentioning

confidence: 99%

Multiple Myeloma: A Rare Haematological Cause of Nasal Septal Perforation and a Vasculitis Mimic

Jain

Balasubramaniam

Nampoothiri

et al. 2016

Indian J Hematol Blood Transfus

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Multiple myeloma (MM) is characterized by malignant proliferation of plasma cells derived from a single clone producing monoclonal immunoglobulins and end organ dysfunction commonly described as ''CRAB'' features [1]. We describe a 34-year old gentleman who presented to our hematology clinic with complaints of epistaxis and low grade fever since 8 months and nodular skin lesions for 3 months. He denied any trauma, cocaine abuse, genital lesions, haematuria and hemoptysis. General examination was remarkable for pallor, papulo-nodular, erythematous, non-tender and non-hemorrhagic lesions distributed over shoulders and trunk (Fig. 1a, b) and an antero-inferior nasal septal perforation (2 9 2 cm) ( Fig. 2a, b). A clinical possibility of vasculitis possibly granulomatosis polyangiitis was kept. His blood investigations revealed hemoglobin-61 g/L, white cell count-8.9 9 10 9 /L, platelets-216 9 10 3 /L, sedimentation rate-95 mm/h, serum sodium 129 mmol/L, potassium 4.9 mmol/dL, blood urea nitrogen-16 mg/dL, creatinine 1.6 mg/dL, proteins-10.2 mg/dL, albumin-2.51, corrected calcium-11 mg/ dL, b2 microglobulin-5.6 mg/dL and LDH-540U/L. Serum protein electrophoresis (SPEP) identified a prominent M band (5.4 g/dL, IgG k subtype). Twenty four hour urinary protein was 240 mg and was negative for Bence Jones proteins and active sediments. Urine protein electrophoresis (UPEP) and immunofixation (IFE) was unremarkable. Serum free light chain assay revealed j: k-0.05 (j-30 mg/dL, k-600 mg/dL). Chest-X-ray showed pleural effusion in right hemithorax (Fig. 3a). Autoimmune workup (anti-nuclear antibodies and anti-neutrophil cytoplasmic antibodies) and viral markers (HIV serology, Australia antigen and IgG-Hepatitis C) were negative. Contrast enhanced CT of the chest revealed right-sided pleural effusion and a lytic expansile bony lesion on posterior aspect of left 6th rib (Fig. 3b). Pleural fluid analysis revealed a total cell count-3000/mL (70 % lymphocytes and 30 % neutrophils), protein-10.3 g/dL, sugar-84 mg/ dL, adenosine deaminase (ADA)-84 IU/L and a negative polymerase chain reaction for Mycobacterium tuberculosis. Flow cytometry identified an infiltration of pleural fluid by CD 138 positive plasma cells. CT guided biopsy from the lytic bone lesion was suggestive of plasmacytoma. Biopsy from the skin lesions revealed an infiltration by CD 38 and CD 138 positive plasma cells (plasmacytoma) along with deposition of pink amorphous material with apple green birefringence in plane polarized microscopy suggestive of amyloidosis (Fig. 4a-c). Bone marrow aspirate revealed 58 % plasma cells. Nasal septal biopsy performed from the

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Reduced-intensity conditioning allogeneic transplantation is associated with a high incidence of extramedullary relapses in multiple myeloma patients

Cited by 80 publications

References 9 publications

Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome

Extramedullary relapses after allogeneic non-myeloablative stem cell transplantation in multiple myeloma patients do not negatively affect treatment outcome

Clinical impact of immunophenotypic remission after allogeneic hematopoietic cell transplantation in multiple myeloma

Multiple Myeloma: A Rare Haematological Cause of Nasal Septal Perforation and a Vasculitis Mimic

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