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Plasmacytoma relapses in the absence of systemic progression post‐high‐dose therapy for multiple myeloma
Author(s) -
Terpos Evangelos,
Rezvani Katayoun,
Basu Supratik,
Milne Alison E.,
Rose Peter E.,
Scott Geoffrey L.,
Rahemtulla Amin,
Samson Diana,
Apperley Jane F.
Publication year - 2005
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.2005.00531.x
Subject(s) - plasmacytoma , multiple myeloma , medicine , systemic therapy , oncology , cancer , breast cancer
Autologous (ASCT) and allogeneic stem cell transplantations (alloBMT) are well‐established therapies for multiple myeloma. However, patients continue to relapse at a constant rate. We present here 15 out of 163 patients who underwent SCT and relapsed with plasmacytomas only without evidence of bone marrow disease progression (14/147 post‐ASCT and 1/16 post‐alloBMT). The median time from SCT to plasmacytoma relapse was 24 months. The sites of plasmacytoma included bone, skin, rectum, and testicles. Five patients were treated with local radiotherapy, while seven patients received a combination of radiotherapy and chemotherapy or thalidomide, and two patients received chemotherapy alone with or without thalidomide. The recipient of alloBMT was initially treated with VAD‐chemotherapy and local radiotherapy followed by a mini‐allograft from the original donor. Eleven patients died at a median of 10 months following diagnosis of the plasmacytoma. Four are still alive, 12–20 months post‐plasmacytoma diagnosis. These cases of unconventional disease recurrence are likely to be seen due to sub‐clinical seeding of tumour cells suggestive of the presence of an extramedullary (EM) clone of plasma cells with a high degree of chemoresistance. We also review all the available data in the literature for the optimal therapy for patients with isolated EM relapse.