Guidelines Summary

The National Comprehensive Cancer Network (NCCN) has released guidelines for the management of multiple myeloma that includes the following specific recommendations for treatment and surveillance of solitary plasmacytoma^[33]:

Radiation therapy (40-50 Gy in 1.8–2.0 Gy/fraction) to involved field
Consider surgery if there is structural instability or neurologic compression

The NCCN recommends follow-up surveillance every 3-6 months that includes^[33]:

Complete blood cell count with differential
Serum chemistry: creatinine, albumin, corrected calcium
Serum quantitative immunoglobulins, serum protein electrophoresis, with serum immunofixation electophoresis as needed
24-hour urine for total protein, urine protein electrophoresis with urine immunofixation electophoresis as needed
Serum free light chain assay

The following tests should be completed as clinically indicated:

Serum lactate dehydrogenase (LDH) and beta-2 microglobulin levels
Bone marrow aspirate and biopsy
Skeletal survey
Whole-body MRI or low-dose CT or PET/CT scan

In addition, the NCCN recommends yearly imaging of all plasmacytomas, preferably with the same technique used at diagnosis, for at least 5 years.

Questions

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Author

Suzanne R Fanning, DO Director of Hematology, Greenville Memorial Health System; 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, American Society of Hematology

Disclosure: Received consulting fee from Millenium Pharmaceuticals for review panel membership; Received consulting fee from Celgene Pharmaceuticals for 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, American Society of Hematology

Disclosure: Received income in an amount equal to or greater than $250 from: Celgene corporation.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, 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 Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

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 Society of Hematology

Disclosure: Nothing to disclose.

Acknowledgements

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.

Fernando Perez-Zincer, MD Senior Fellow, Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation Cancer Center

Disclosure: Nothing to disclose.