Skip to main content
Log in

Solitary Plasmacytoma: a Review of Diagnosis and Management

  • Multiple Myeloma (P Kapoor, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Solitary plasmacytoma is a rare plasma cell dyscrasia, classified as solitary bone plasmacytoma or solitary extramedullary plasmacytoma. These entities are diagnosed by demonstrating infiltration of a monoclonal plasma cell population in a single bone lesion or presence of plasma cells involving a soft tissue mass, respectively. Both diseases represent a single localized process without significant plasma cell infiltration into the bone marrow or evidence of end organ damage. Clinically, it is important to classify plasmacytoma as having completely undetectable bone marrow involvement versus minimal marrow involvement. Here, we discuss the diagnosis, management, and prognosis of solitary plasmacytoma.

Recent Findings

There have been numerous therapeutic advances in the treatment of multiple myeloma over the last few years. While the treatment paradigm for solitary plasmacytoma has not changed significantly over the years, progress has been made with regard to diagnostic tools available that can risk stratify disease, offer prognostic value, and discern solitary plasmacytoma from quiescent or asymptomatic myeloma at the time of diagnosis.

Summary

Despite various studies investigating the use of systemic therapy or combined modality therapy for the treatment of plasmacytoma, radiation therapy remains the mainstay of therapy. Much of the recent advancement in the management of solitary plasmacytoma has been through the development of improved diagnostic techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ozsahin M, Tsang RW, Poortmans P, Belkacémi Y, Bolla M, Öner Dinçbas F, et al. Outcomes and patterns of failure in solitary plasmacytoma: a multicenter rare cancer network study of 258 patients. Int J Radiat Oncol Biol Phys. 2006;64:210–7.

    Article  PubMed  Google Scholar 

  2. Nahi H, Genell A, Wålinder G, Uttervall K, Juliusson G, Karin F, et al. Incidence, characteristics, and outcome of solitary plasmacytoma and plasma cell leukemia. Population-based data from the Swedish myeloma register. Eur J Haematol. 2017;99(3):216–22.

    Article  PubMed  Google Scholar 

  3. Warsame R, Gertz MA, Lacy MQ, Kyle RA, Buadi F, Dingli D, et al. Trends and outcomes of modern staging of solitary plasmacytoma of bone. Am J Hematol. 2012;87:647–51.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dimopoulos MA, Hamilos G. Solitary bone plasmacytoma and extramedullary plasmacytoma. Curr Treat Options in Oncol. 2002;3:255–9.

    Article  Google Scholar 

  5. Zamagni E, Patriarca F, Nanni C, Zannetti B, Englaro E, Pezzi A, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood. 2011;118:5989–95.

    Article  CAS  Google Scholar 

  6. Hillner BE, Siegel BA, Shields AF, Liu D, Gareen IF, Hunt E, et al. Relationship between cancer type and impact of PET and PET/CT on intended management: findings of the national oncologic PET registry. J Nucl Med. 2008;49:1928–35.

    Article  PubMed  Google Scholar 

  7. Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, et al. Role of (18)F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol. 2017;18(4):e206–17.

    Article  PubMed  Google Scholar 

  8. Zamagni E, Nanni C, Patriarca F, Englaro E, Castellucci P, Geatti O, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92:50–5.

    Article  PubMed  Google Scholar 

  9. Baur-Melnyk A, Buhmann S, Becker C, Schoenberg SO, Lang N, Bartl R, et al. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. Am J Roentgenol. 2008;190:1097–104.

    Article  Google Scholar 

  10. Dinter DJ, Neff WK, Klaus J, Böhm C, Hastka J, Weiss C, et al. Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy. Ann Hematol. 2009;88:457–64.

    Article  PubMed  Google Scholar 

  11. Salaun PY, Gastinne T, Frampas E, Bodet-Milin C, Moreau P, Bodéré-Kraeber F. FDG-positron-emission tomography for staging and therapeutic assessment in patients with plasmacytoma. Haematologica. 2008;93(8):1269–71.

    Article  PubMed  Google Scholar 

  12. Mendenhall WM, Mendenhall CM, Mendenhall NP. Solitary plasmacytoma of bone and soft tissues. Am J Otolaryngol. 2003;24:395–9.

    Article  PubMed  Google Scholar 

  13. Reed V, Shah J, Medeiros LJ, Ha CS, Mazloom A, Weber DM, et al. Solitary plasmacytomas: outcome and prognostic factors after definitive radiation therapy. Cancer. 2011;117(19):4468–74.

    Article  PubMed  Google Scholar 

  14. Tsang RW, Gospodarowicz MK, Pintilie M, Bezjak A, Wells W, Hodgson DC, et al. Solitary plasmacytoma treated with radiotherapy: impact of tumor size on outcome. Int J Radiat Oncol Biol Phys. 2001;50:113–20.

    Article  CAS  PubMed  Google Scholar 

  15. Knobel D, Zouhair A, Tsang RW, et al. Prognostic factors in solitary plasmacytoma of the bone: a multicenter rare cancer network study. BMC Cancer. 2006;6:118.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mendenhall CM, Thar TL, Million RR. Solitary plasmacytoma of bone and soft tissue. Int J Radiat Oncol Biol Phys. 1980;6:1497–501.

    Article  CAS  PubMed  Google Scholar 

  17. Tournier-Rangeard L, Lapeyre M, Graff-Caillaud P, Mege A, Dolivet G, Toussaint B, et al. Radiotherapy for solitary extramedullary plasmacytoma in the head-and-neck region: a dose greater than 45 Gy to the target volume improves the local control. Int J Radiat Oncol Biol Phys. 2006;64:1013–7.

    Article  PubMed  Google Scholar 

  18. • Caers J, Paiva B, Zamagni E, Leleu X, Bladé J, et al. Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. J Hematol Oncol. 2018;11(1):10. This is an excellent review of solitary plasmacytoma which includes consensus recommendations regarding radiation therapy.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Tsang RW, Campbell BA, Goda JS, Kelsey CR, Kirova YM, Parikh RR, et al. Radiation therapy for solitary plasmacytoma and multiple myeloma: guidelines from the international lymphoma radiation oncology group. Int J Radiat Oncol Biol Phys. 2018;101(4):794–808.

    Article  PubMed  Google Scholar 

  20. Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B, et al. Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. Cancer. 1999;85:2305–14.

    Article  CAS  PubMed  Google Scholar 

  21. Holland J, Trenkner DA, Wasserman TH, Fineberg B. Plasmacytoma. Treatment results and conversion to myeloma. Cancer. 1992;69:1513–7.

    Article  CAS  PubMed  Google Scholar 

  22. Mheidly K, Lamy T, Escoffre M, Hunault M, Benboubker L, Esvan M, et al. Adjuvant chemotherapy in the treatment of solitary bone plasmacytoma. Blood. 2016;128(22):4514.

    Google Scholar 

  23. Mhaskar R, Kumar A, Miladinovic B, Djulbegovic B. Bisphosphonates in multiple myeloma: an updated network meta-analysis. Cochrane Database Syst Rev. 2017;12:CD003188.

    PubMed  Google Scholar 

  24. Wilder RB, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Persistence of myeloma protein for more than 1 year after radiotherapy is an adverse prognostic factor in solitary plasmacytoma of bone. Cancer. 2002;94:1532–7.

    Article  CAS  PubMed  Google Scholar 

  25. Dingli D, Kyle RA, Rajkumar SV, et al. Immunoglobulin free light chains and solitary plasmacytoma of bone. Blood. 2006;108:1979–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Boll M, Parkins E, O’Connor SJM, Rawstron AC, Owen RG. Extramedullary plasmacytoma are characterized by a ‘myeloma-like’ immunophenotype and genotype and occult bone marrow involvement. Br J Haematol. 2010;151:525–7.

    Article  PubMed  Google Scholar 

  27. • Paiva B, Chandia M, Vidriales MB, Colado E, et al. Multiparameter flow cytometry for staging of solitary bone plasmacytoma: new criteria for risk of progression to myeloma. Blood. 2014;124:1300–3. This study demonstrated the importance of flow cytometry assessment of bone marrow at diagnosis. It was one of two studies to separately demonstrate that bone marrow plasmacytosis detectable by flow cytometry strongly predicted progression to multiple myeloma.

    Article  CAS  PubMed  Google Scholar 

  28. • Hill QA, Rawstron AC, de Tute RM, Owen RG. Outcome prediction in plasmacytoma of bone: a risk model utilizing bone marrow flow cytometry and light-chain analysis. Blood. 2014;124:1296–9. This study demonstrated the importance of flow cytometry assessment of bone marrow at diagnosis. It was one of two studies to separately demonstrate that bone marrow plasmacytosis detectable by flow cytometry strongly predicted progression to multiple myeloma.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anuj Mahindra.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Multiple Myeloma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pham, A., Mahindra, A. Solitary Plasmacytoma: a Review of Diagnosis and Management. Curr Hematol Malig Rep 14, 63–69 (2019). https://doi.org/10.1007/s11899-019-00499-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-019-00499-8

Keywords

Navigation