Extramedullary Plasmacytoma Treatment & Management

  • Author: Suzanne R Fanning, DO; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Nov 22, 2011
 

Medical Care

  • Solitary bone plasmacytoma (SBP)
    • Local radiotherapy is the treatment of choice.[4, 5, 13, 23] Treatment fields should be designed to encompass all disease observed on MRI and should include a margin of healthy tissue (at least 2 cm). For spinal lesions, the margins should include at least 1 uninvolved vertebra.
    • Local control is achieved in 88-100% of patients. Virtually all patients have major symptom relief.[13] and a local tumor recurrence rate of approximately 10%.
    • Most centers use approximately 40 Gy for spinal lesions and 45 Gy for other bone lesions. For lesions larger than 5 cm, 50 Gy should be considered.
    • No dose-response relationship between radiation dose and disappearance of monoclonal protein was noted in a series of patients with solitary bone plasmacytoma as reported by Liebross et al.[23]
    • Monoclonal protein is markedly reduced after radiotherapy in the majority of patients, but protein disappearance is observed in only 20-50% of patients.[14]
    • Surgery is contraindicated in the absence of structural instability or neurologic compromise.[12]
    • Chemotherapy may be considered for patients not responding to radiation therapy. Regimens useful in multiple myeloma can be considered.[12]
    • No role exists for adjuvant chemotherapy in solitary bone plasmacytoma (SBP).
  • Extramedullary plasmacytoma (EMP)
    • Based on the documented radiation sensitivity of plasma cell tumors, the accepted treatment is radiotherapy.
    • When a lesion can be completely resected, surgery provides the same results as radiotherapy.
    • Combined therapy (surgery and radiotherapy) is an accepted treatment depending on the resectability of the lesion.[4, 6, 13, 14, 15] In fact, combination treatment may provide the best results.[14]
    • The optimal dose for local control is 40-50 Gy (depending on tumor size) delivered over 4-6 weeks.[13, 14, 15]
    • Because of the high rate of lymph node involvement, these areas should be included in the radiation field.[13]
    • Adjuvant radiotherapy should be recommended to patients with positive surgical margins.
    • Chemotherapy may be considered for patients with refractory or relapsed disease. Regimens used for multiple myeloma can be considered.[12]
    • Adjuvant chemotherapy may be considered for patients with tumors larger than 5 cm, as well as those with high-grade histology.
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Surgical Care

  • Although surgical resection is not advised for the treatment of solitary bone plasmacytoma (SBP), spine instrumentation or another procedure is sometimes necessary to try to reestablish the normal architecture of the spine or other bone affected.
  • If possible, a complete resection of the lesion, including lymph node dissection, should be attempted for soft-tissue plasmacytomas.
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Consultations

  • Orthopedic evaluation is recommended for patients with solitary bone plasmacytoma (SBP) because lesions may cause spinal cord compression syndrome or impending fractures. Therapeutic procedures, such as kyphoplasty, can be implemented in order to restore vertebral structure.
  • An ear, nose, and throat evaluation is recommended for patients with extramedullary plasmacytoma (EMP) of the head and neck to precisely localize the lesion, obtain an adequate biopsy (including lymph nodes), and plan possible resection.
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Contributor Information and Disclosures
Author

Suzanne R Fanning, DO  Fellow, Department of Hematology and Medical Oncology, Cleveland Clinic Foundation, 2004-2007 Director, Hematology, Greenville Memorial Health System, Greenville, SC Medical Oncologist/Hematologist/Transplant Physician, Cancer Centers of the Carolinas

Suzanne R Fanning, DO is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, and American Society of Hematology

Disclosure: Millenium Pharmaceuticals Consulting fee Review panel membership; Celgene Pharmaceuticals Consulting fee Review panel membership

Coauthor(s)

Mohamad A Hussein, MD  Clinical Director, Malignant Hematology, Moffitt Cancer Center

Mohamad A Hussein, MD is a member of the following medical societies: American Association of Blood Banks, American College of Physicians, American Medical Association, and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul Schick, MD  Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Dr Fernando Perez-Zincer to the development and writing of this article.

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