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Extramedullary Tumors- Myeloma

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Experts have yet to reach a consensus regarding the optimal treatment modality for extramedullary plasmacytoma (EMP). Current guidelines stipulate…

Dear Cancer Coach- I am a 6 year survivor of multiple myeloma in complete remission  (CR). I am having the usual battery of blood work every 6 months. With the new findings about non marrow tumors aka extramedullary tumors, I wonder if you know if blood work and exam by onc would be likely to reveal them?

I went into CR after 3 cycles of Revlimid/Dexamethasone, had an autologous stem cell transplant (ASCT) in April 07, with no maintenance.

Thank you, David, for all that you are doing. I hope you are healthy.


First the good news. Achieving complete remission (CR) after only 3 cycles of rev/dex is excellent. “I went into cr after 3 cycles of rec/dex, had act in April 07, with no maintenance.” Six years in CR is great as it predicts a long overall survival.

As for your question “I wonder if you know if blood work and exam by onc would be likely to reveal them (extramedully tumors) ? The excerpt below from The NCI website implies that monoclonal protein (m protein) blood testing does reveal “extramedullary tumors” or plasmacytomas. I can’t say, however, that blood work always reveals plasmacytomas.

Are you worried about coming out of CR and thinking that there might be another plasmacytoma or extramedullary tumor hiding somewhere inside you?

How old are you?  Do you pursue any cancer fighting therapies such as exercise, nutrition, supplementation, etc? Are you experiencing any bone pain? What has your blood work over the past six years indicated? Are you staying in the “normal” range?

To Learn More About Extramedullary Myeloma- click now

Let me know and thanks

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

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Extramedullary Plasmacytoma Treatment & Management

“Due to the rarity of solitary plasmacytoma (SP), there are no randomized studies to inform the best treatment approach, and the available data from small case series are controversial. Radiotherapy is the treatment of choice for SP, although its efficacy has been tested only in small retrospective series. [42]

Experts have yet to reach a consensus regarding the optimal treatment modality for extramedullary plasmacytoma (EMP). Current guidelines stipulate that head and neck EMP be treated with radiotherapy only, as surgical resection of these tumors can be highly invasive. [44]

In the retrospective study by Thumallapally et al, 825 patients (49%) received radiotherapy and 197 (12%) underwent surgery, while 359 patients (21%) required both radiotherapy and surgery. The majority of SBP patients received radiation, while patients with EMP of upper airway tract and the central nervous system most commonly received radiotherapy plus surgery; those with lower airway tract involvement received radiotherapy only or neither radiotherapy nor surgery, and those with gastrointestinal tract localization were more frequently treated with surgery only. [2]

The survival rates of patients treated with radiotherapy were significantly higher than those of patients who did not receive radiotherapy (64.4% vs. 48.6%, P <0.05). Moreover, patients who received neoadjuvant radiotherapy had a greater chance of 5-year relative survival than those who received adjuvant radiotherapy (86% vs. 73%, P <0.05). A significant difference in survival was also observed in patients who underwent surgery, compared with patients who did not (69.7% vs 57.4%, P <0.05).<ref>2 </ref>​

“Standard treatment options for extramedullary plasmacytoma include the following:

  1. Radiation therapy to the isolated lesion with fields that cover the regional lymph nodes, if possible.[1,2]
  2. In some cases, surgical resection may be considered, but it is usually followed by radiation therapy.[2]
  3. If the monoclonal (or myeloma) protein (M protein) persists or reappears, the patient may need further radiation therapy. In some patients, the plasmacytoma may shrink, but not disappear, and the M protein persists. These types of patients should be followed closely. Surgery should be performed if the plasmacytoma is in a site where it can be removed easily (e.g., in the tonsil); the M protein may disappear from the blood or urine. In other cases, persistence or an increasing M protein may herald progression to multiple myeloma.”


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