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Solitary Plasmacytoma
The most common of these is solitary plasmacytoma of bone (SPB), accounting for 3–5% of all plasma cell malignancies.[2] SPBs occur as lytic lesions within the axial skeleton and extramedullary plasmacytomas most often occur in the upper respiratory tract (85%), but can occur in any soft tissue.
I was diagnosed with a solitary plasmacytoma in early 1994. I underwent surgical resection of the lesion followed by l0cal radiation to the area (fifth cervical vertebra) to zap any remaining monoclonal proteins (MM cells) that remained.
According to the studies linked and excerpted below, this therapy plan- surgery and radiation- results in the best overall survival for a solitary plasmacytoma of bone (SBP).
My SBP became full multiple myeloma (MM) in less than a year. I then underwent the standard-of-care therapies for newly diagnosed multiple myeloma including induction therapy followed by an autologous stem cell transplant.
I relapsed less than a year after my ASCT underwent more local radiation (to my iliac crest), relapsed nine months after that when my oncologist then told me the she could do nothing more for me.
My point in recounting my tale of woe is not to elicit sympathy but to give you a sense of
- A diagnosis of a single plasmacytoma of bone
- Standard therapy for an SBP and
- how difficult it is to predict overall survival for MM in general and especially the rare diagnosis of pre-mm stage called a SBP.
The study below has correctly identified two of the most critical prognostic factors for a SBP diagnosis.
- “In our study, we found that patients older than 60 years had worse survival rates.”
- “In the current study, we found that patients with grade III tumor had a worse outcome. Wang et al found that Grade II tumor had a worse outcome.12″
However, unknowns such as monoclonal proteins that got away- remember that MM is a blood cancer- can turn any prognosis on it’s head. Which is what happened to me.
Regardless of your prognosis, good or bad, short or long, please consider evidence-based, non-conventional, non-toxic therapies such as anti-angiogenic nutrition, supplementation and lifestyle therapies.
To learn more about evidence-based, non-conventioal therapies please scroll down the page, post a question or a comment and I will reply to you ASAP.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- UAMS is CURING 30% of Low-Risk Myeloma?!?!
- Myeloma Survivor 2.5 years Post ASCT- What’s next?
- Chemotherapy for Smoldering Multiple Myeloma???
Plasmacytoma
“Plasmacytoma is a plasma cell dyscrasia in which a plasma cell tumour grows within soft tissue or within the axial skeleton.
The International Myeloma Working Group lists three types: solitary plasmacytoma of bone (SPB); extramedullary plasmacytoma (EP), and multiple plasmacytomas that are either primary or recurrent.[1] The most common of these is SPB, accounting for 3–5% of all plasma cell malignancies.[2] SPBs occur as lytic lesions within the axial skeleton and extramedullary plasmacytomas most often occur in the upper respiratory tract (85%), but can occur in any soft tissue. Approximately half of all cases produce paraproteinemia. SPBs and extramedullary plasmacytomas are mostly treated with radiotherapy, but surgery is used in some cases of extramedullary plasmacytoma. The skeletal forms frequently progress to multiple myeloma over the course of 2–4 years.[3]
Due to their cellular similarity, plasmacytomas have to be differentiated from multiple myeloma. For SPB and extramedullary plasmacytoma the distinction is the presence of only one lesion (either in bone or soft tissue), normal bone marrow (<5% plasma cells), normal skeletal survey, absent or low paraprotein and no end organ damage.[1]…
Treatment[edit]
Radiotherapy is the main choice of treatment for both SPB and extramedullary plasmacytoma, and local control rates of >80% can be achieved. This form of treatment can be used with curative intent because plasmacytoma is a radiosensitive tumor. Surgery is an option for extramedullary plasmacytoma, but for cosmetic reasons it is generally used when the lesion is not present within the head and neck region.[3][4][7]
Prognosis[edit]
Most cases of SPB progress to multiple myeloma within 2–4 years of diagnosis, but the overall median survival for SPB is 7–12 years. 30–50% of extramedullary plasmacytoma cases progress to multiple myeloma with a median time of 1.5–2.5 years. 15–45% of SPB and 50–65% of extramedullary plasmacytoma are disease free after 10 years.[3]
Prognostic Nomogram for Predicting Overall Survival of Solitary Bone Plasmacytoma Patients: A Large Population-Based Study
“Solitary plasmacytoma (SP) is a rare type of plasma cell dyscrasia, being cytological and immuno-phenotypically identical to plasma cell myeloma. SP can be divided into two types:
- solitary plasmacytoma of bone (SPB) and
- solitary extramedullary plasmacytoma (SEP).1
SPB is caused by the colonel proliferation of plasma cells, which does not share other features with multiple myeloma (MM)2 or show evidence of systemic disease originating from bones.3
Approximately 5% of all cases of plasma cell disorders are SPB,1 and 70% of all SP cases are SPB that mainly occurs on the axial skeleton.4,5Approximately half of the SBP patients are associated with a high risk of developing MM in 2 to 3 years.6 The primary therapy was radiotherapy, though surgery is also required in some cases,1,7 while the use of chemotherapy remains controversial.8…
The multivariable regression analysis was performed to obtain the significant prognosis that was used to establish the nomogram for 3-, 5-, and 10-year OS…
In our study, 376 SPB patients from the SEER database were analyzed. Multivariable analysis indicated that
- age,
- marital status,
- histological grade,
- and tumor treatments
are independent prognostic factors for OS. Several studies suggested that age is a vital predictor in the survival of malignant tumors.15–17 In our study, we found that patients older than 60 years had worse survival rates. A similar result was found in another previous study.3 Dores et al reported that the 5-year survival for SBP patients was the most favorable among the younger age group (<60 years; 76.8%) and the poorest among the older age group (≥60 years; 53.3%) (P<0.0001).9 A possible explanation is that with the increase of age, the immune function gradually weakens, and the immune monitoring and elimination of mutant cells are compromised…
In the current study, we found that patients with grade III tumor had a worse outcome. Wang et al found that Grade II tumor had a worse outcome.12…
Most treatment recommendations are based on expert consensus and are still controversial.
- Radiotherapy,
- surgery, and
- chemotherapy
are the three main treatments. Radiotherapy is the primary treatment for SBP that is highly sensitive to radiation,24 which usually has a local control rate of about 94% at doses of 40 to 45 Gy.25 Surgery is a reliable option for patients with nerve injury and spinal instability.26 It is not only a part of the diagnostic procedure but also the treatment of fracture fixation, laminectomy, or spinal stabilization.4 Surgery is a milestone for the histological diagnosis and specific treatment for plasmacytoma with distinct localizations.3
However, our study found that surgery combined with radiotherapy was a protective factor of OS, compared with radiation only or surgery only. Moreover, patients who were only treated with surgery were associated with a nearly 2.7-time higher risk of death…
Conclusion
Based on the SEER cohort, marital status, age, grade, treatment were identified as independent prognostic indicators for OS in SBP patients. We constructed a nomogram and risk classification system to predict the OS of SBP patients. The nomogram showed good applicability and great accuracy, and it could serve as a reliable tool for predicting OS in SBP patients, though further clinical verification is needed…”