Extramedullary Plasmacytoma Follow-up

Updated: Dec 01, 2015
  • Author: Suzanne R Fanning, DO; Chief Editor: Emmanuel C Besa, MD  more...
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Follow-up

Further Outpatient Care

See the list below:

  • Periodic evaluation for progression and development of multiple myeloma is recommended every 6 weeks for the first 6 months for solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP), with extension of clinic appointments thereafter. Besides a complete history and physical examination, the following tests are recommended:
    • Complete blood cell (CBC) count
    • Complete metabolic panel with lactic dehydrogenase (LDH), calcium, phosphorus, C-reactive protein (CRP), and beta2 microglobulin
    • Erythrocyte sedimentation rate (ESR)
    • Serum protein electrophoresis with immunofixation
    • Serum immunoglobulin quantification
    • Urinary protein electrophoresis with immunofixation (24-h urine sample)
    • Skeletal bone survey
  • Orthopedic follow-up is recommended for solitary bone plasmacytoma (SBP) and/or ear-nose-throat follow-up is recommended extramedullary plasmacytoma (EMP), based on the tumor location.
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Prognosis

See the list below:

  • Solitary bone plasmacytoma (SBP)
    • Solitary bone plasmacytoma (SBP) progresses to multiple myeloma at a rate of 65-84% at 10 years and 65-100% at 15 years.
    • The median onset of conversion to multiple myeloma is 2-5 years with a 10-year disease-free survival rate of 15-46%.
    • The overall median survival time is 10 years. [16]
    • Kyle described 3 patterns of treatment failure [19] : development of multiple myeloma (54%), local recurrence (11%), and development of new bone lesions in the absence of multiple myeloma (2%).
    • Prognostic features for conversion of solitary bone plasmacytoma (SBP) to multiple myeloma, although controversial, include the following [1, 29, 34] :
      • Lesion size of at least 5 cm
      • Patients aged 40 years and older
      • High M protein levels
      • Persistence of M protein after treatment
      • Spine lesions
    • In a study by Wilder et al, 10-year myeloma-free survival was 91% versus 29% in patients whose M-protein did or did not resolve at 1 year following radiation therapy. [42]
  • Extramedullary plasmacytoma (EMP)
    • The 10-year overall survival rate is 70%. [15]
    • The rate of progression to multiple myeloma is lower than in solitary bone plasmacytoma (SBP), ranging from 11% to 30% at 10 years. [16] Patients with extramedullary plasmacytoma who progressed to multiple myeloma had a 5-year survival rate of 100%, compared with 33% for solitary bone plasmacytoma. [43] In a review of 721 cases by Alexiou and colleagues, after treatment, approximately 65% of patients were free of recurrence and did not progress to multiple myeloma, 22% experienced recurrence, and 15% of cases evolved to multiple myeloma. [17]
    • In one study, local control following radiation therapy was achieved in 83% of patients with low-grade histology versus 17% of patients with intermediate- to high-grade tumors. [41]
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