Abstract

Objective

  The International Myeloma Working Group in 2003 recognized a separate classification of plasmacytomas that occur as multiple sites of disease in soft tissue, bone, or both  as multiple solitaryplasmacytoma (MSP). There are only few cases of MSP described in literatures. As a rare mylema, relatively little is known about its features, treatment response, and survival.

Method

  we have retrospectively analyzed nine patients with MSP in our hospital from 2009 to 2013.

Result 

The median age was 49 (26-49) years old. There were six males and three females. All but one had M-protein in serum and/ or urine. There was a predominance of lambda light chain (6/8). Most cases had multiple bone lesions (8/9).Only one had multiple solitary extramedullary plasmacytoma localized on CNS tissue and right lumber. Most (6/9) were stage III of DS for and seven cases were stage I of ISS. Six patients were treated with regimen containing bortezomib as induction therapy. And one of them underwent high-dose of chemotherapy with autologous stem cell transplantation (HDT/ASCT) at CR as part of their front-line therapy. Another three patients were treated with conventional alkylating agent combined with glucocorticoid based chemotherapy. After initial chemotherapy, seven patients reached CR, one PR. In first line combinational chemotherapy that containing bortezomib (Btz) (n=6), 100% patients achieved CR ,compared with that of 33.3% in patients treated with conventional chemotherapy (=0.083). Date cut-off was July 20, 2013, a median follow-up of 28.5 (range2-38) months. The median OS time was 29, median progression -free survival (PFS) was 8 months. However, none of them progressed to MM. In addition, compared with the patients whose regimes included Btz (n=6), the patients who got conventional chemotherapy (n=3) had a trend towards poorer median OS (not reach versus 28 months, = 0.116) and shorter median PFS (6 months versus 38 months, = 0.356).

Conclusion

 MSP was at early stage at diagnosed. Most cases were male and λ light chain type. Although there was a good treatment response, these patients easily progressed. ISS may not suitable for evaluation of prognosis with MSP.Bortezomib based therapy could further deepen degree of remission , prolong the survival.

Table 1
 age sex isotype DS ISS Mass site mass size Multiple Bone lesion PFS OS 
51 Dλ IIIA Scapula, sternum >5cm 28 
39 κ IIIA Scapula <5cm 29 
42 λ IA III Scapula humerus  >5cm 29 
26 Gλ IIIA CNS >5cm 36 38 
49 Aκ IIIA NO   17 17 
69 Dλ IA chestwall <5cm 24 24 
39 Aλ IIA III Mandible, breast >5cm 35 
51 None IA CNS, lumber <5cm   
61 Gλ IIIA Sacral, limbs, Supraclav--icular >5cm 
 age sex isotype DS ISS Mass site mass size Multiple Bone lesion PFS OS 
51 Dλ IIIA Scapula, sternum >5cm 28 
39 κ IIIA Scapula <5cm 29 
42 λ IA III Scapula humerus  >5cm 29 
26 Gλ IIIA CNS >5cm 36 38 
49 Aκ IIIA NO   17 17 
69 Dλ IA chestwall <5cm 24 24 
39 Aλ IIA III Mandible, breast >5cm 35 
51 None IA CNS, lumber <5cm   
61 Gλ IIIA Sacral, limbs, Supraclav--icular >5cm 

M: male; F: female; Y:yes;N:no.

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.