How We Manage Patients with Plasmacytomas
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Purpose of Review
To discuss the diagnostic approach, treatment options, and future considerations in the management of plasmacytomas, either solitary or in the context of overt multiple myeloma (MM).
Advanced imaging techniques such as whole-body magnetic resonance imaging and positron emission tomography/computerized tomography are essential for the diagnostic workup of solitary plasmacytomas (SP) to rule out the presence of other disease foci. The role of flow cytometry and clonal plasma cell detection is currently under study together with other prognostic factors for the identification of patients with SP at high risk of progression to overt MM. Solitary plasmacytomas are treated effectively with local radiotherapy whereas systemic therapy is required at relapse. Clonal plasma cells that accumulate at extramedullary sites have distinct biological characteristics. Patients with MM and soft tissue involvement have poor outcomes and should be treated as ultra-high risk.
A revised definition of SP that distinguishes between true solitary clonal PC accumulations and SP with minimal bone marrow involvement should be considered to guide an appropriate therapeutic and follow-up approach. Future studies should be conducted to determine optimum treatment approaches for patients with MM and paraskeletal or extramedullary disease.
KeywordsPlasma cells Tumor Solitary lesion Bone disease Extramedullary
Compliance with Ethical Standards
Conflict of Interest
Dr. Dimopoulos reports personal fees from Amgen, personal fees from Celgene, personal fees from Janssen, and personal fees from Takeda, during the conduct of the study. Dr. KASTRITIS reports personal fees from Amgen, personal fees from Genesis Pharma, personal fees from Janssen, personal fees from Takeda, and personal fees from Prothena, during the conduct of the study. Dr. Fotiou has nothing to disclose.
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.
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