301
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Papanikolaou X, Repousis P, Tzenou T, Maltezas D, Kotsopoulou M, Megalakaki K, Angelopoulou M, Dimitrakoloulou E, Koulieris E, Bartzis V, Pangalis G, Panayotidis P, Kyrtsonis MC. Incidence, clinical features, laboratory findings and outcome of patients with multiple myeloma presenting with extramedullary relapse. Leuk Lymphoma 2012; 54:1459-64. [PMID: 23151071 DOI: 10.3109/10428194.2012.746683] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Extramedullary plasmacytomas constitute a rare and not well studied subset of multiple myeloma (MM) relapses. We report the incidence, clinical-laboratory features and outcome of patients with MM and extramedullary relapse (ExMeR). A total of 303 patients with symptomatic MM were recorded in a 13-year period in two institutions. Twenty-eight cases of ExMeR (9%) were recorded. There was an increased frequency of elevated lactate dehydrogenase (LDH) (p = 0.026), bone plasmacytomas (p = 0.001) and fractures (p = 0.002) at diagnosis, in patients with ExMeR compared to the others. ExMeR was associated with an ominous outcome, high LDH, constitutional symptoms and a statistically significant decrease of monoclonal paraprotein compared to levels at diagnosis (p = 0.009). Prior treatment with bortezomib was associated with a decreased hazard of ExMeR (p = 0.041). Overall survival (OS) was decreased in patients with ExMeR compared to the others (38 vs. 59 months, p = 0.006). Patients with MM with ExMeR have a lower OS and their clinical and laboratory features differ from those without.
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Affiliation(s)
- Xenofon Papanikolaou
- First Department of Propaedeutic Internal Medicine-Hematology Section, Laikon University Hospital, Athens, Greece
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302
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La Verde N, Moretti A, Bramati A, Bianchi F, Gherardi G, Piva S, Girelli S, Pedretti D, Farina G. Multiple myeloma with prostate involvement: a case report. J Clin Oncol 2012; 30:e306-8. [PMID: 22965957 DOI: 10.1200/jco.2012.42.7179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicla La Verde
- Oncology Department, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan.
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303
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Role of whole-body 64-slice multidetector computed tomography in treatment planning for multiple myeloma. Radiol Med 2012; 118:799-805. [PMID: 22986700 DOI: 10.1007/s11547-012-0880-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/03/2012] [Indexed: 01/06/2023]
Abstract
PURPOSE The authors evaluated the role of whole-body 64-slice multidetector computed tomography (WB-MDCT) in treatment planning for multiple myeloma. MATERIAL AND METHODS This was a prospective study of 28 consecutive patients with multiple myeloma (19 men, nine women; age range, 51-73 years; mean age, 60 years) who underwent WB-MDCT and conventional radiography (CR) of the skeleton. The images were interpreted for the presence of bony lesions, medullary lesions, fractures and extraosseous lesions. We evaluated any changes in treatment planning as a result of WB-MDCT findings. RESULTS WB-MDCT was superior to CR for detecting bony lesions (p=0.001), especially of the spine (p=0.001) and thoracic cage (p=0.006). WB-MDCT upstaged 14 patients, with a significant difference in staging (p=0.002) between WB-MDCT and CR. Medullary involvement either focal (n=6) or diffuse (n=3) had a positive correlation with the overall score (r=0.790) and stage (r=0.618) of disease. Spine fractures were better detected at WB-MDCT (n=4) than at CR (n=2). Extraosseous soft tissue lesions (n=7) were detected only at WB-MDCT. Findings detected at the WB-MDCT led to changes in the patient's treatment plan in 39% of cases. Upstaging of seven patients (25%) altered the medical treatment plan, and four of 28 (14%) patients required additional radiotherapy (7%) and vertebroplasty (7%). CONCLUSIONS We conclude that WB-MDCT has an impact on treatment planning and prognosis in patients with multiple myeloma, as it has high rate of detecting cortical and medullary bone lesions, spinal fracture and extraosseous lesions. This information may alter treatment planning in multiple myeloma due to disease upstaging and detection of spine fracture and extraosseous spinal lesions.
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304
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Mussetti A, Dalto S, Montefusco V. Effective treatment of pomalidomide in central nervous system myelomatosis. Leuk Lymphoma 2012; 54:864-6. [DOI: 10.3109/10428194.2012.718343] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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305
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Vigo F, Ciammella P, Valli R, Cagni E, Iotti C. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature. J Med Case Rep 2012; 6:236. [PMID: 22883512 PMCID: PMC3459698 DOI: 10.1186/1752-1947-6-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 06/08/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.
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Affiliation(s)
- Federica Vigo
- Department of Advanced Technologies, Radiation Oncology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
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306
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Waheed S, Mitchell A, Usmani S, Epstein J, Yaccoby S, Nair B, van Hemert R, Angtuaco E, Brown T, Bartel T, McDonald J, Anaissie E, van Rhee F, Crowley J, Barlogie B. Standard and novel imaging methods for multiple myeloma: correlates with prognostic laboratory variables including gene expression profiling data. Haematologica 2012; 98:71-8. [PMID: 22733020 DOI: 10.3324/haematol.2012.066555] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Multiple myeloma causes major morbidity resulting from osteolytic lesions that can be detected by metastatic bone surveys. Magnetic resonance imaging and positron emission tomography can detect bone marrow focal lesions long before development of osteolytic lesions. Using data from patients enrolled in Total Therapy 3 for newly diagnosed myeloma (n=303), we analyzed associations of these imaging techniques with baseline standard laboratory variables assessed before initiating treatment. Of 270 patients with complete imaging data, 245 also had gene expression profiling data. Osteolytic lesions detected on metastatic bone surveys correlated with focal lesions detected by magnetic resonance imaging and positron emission tomography, although, in two-way comparisons, focal lesion counts based on both magnetic resonance imaging and positron emission tomography tended to be greater than those based on metastatic bone survey. Higher numbers of focal lesions detected by magnetic resonance imaging and positron emission tomography were positively linked to high serum concentrations of C-reactive protein, gene-expression-profiling-defined high risk, and the proliferation molecular subgroup. Positron emission tomography focal lesion maximum standardized unit values were significantly correlated with gene-expression-profiling-defined high risk and higher numbers of focal lesions detected by positron emission tomography. Interestingly, four genes associated with high-risk disease (related to cell cycle and metabolism) were linked to counts of focal lesions detected by magnetic resonance imaging and positron emission tomography. Collectively, our results demonstrate significant associations of all three imaging techniques with tumor burden and, especially, disease aggressiveness captured by gene-expression-profiling-risk designation. (Clinicaltrials.gov identifier: NCT00081939).
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Affiliation(s)
- Sarah Waheed
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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307
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Usmani SZ, Heuck C, Mitchell A, Szymonifka J, Nair B, Hoering A, Alsayed Y, Waheed S, Haider S, Restrepo A, Van Rhee F, Crowley J, Barlogie B. Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents. Haematologica 2012; 97:1761-7. [PMID: 22689675 DOI: 10.3324/haematol.2012.065698] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Extramedullary disease is an uncommon manifestation in multiple myeloma and can either accompany newly diagnosed disease or develop with disease progression or relapse. We evaluated the impact of this disease feature on patients' outcome in the context of novel agents. DESIGN AND METHODS We analyzed clinical and biological features of extramedullary disease in 936 patients with multiple myeloma enrolled in Total Therapy protocols, 240 patients in non-Total Therapy protocols, and 789 non-protocol patients, all of whom had baseline positron emission tomography scans to document extramedullary disease at diagnosis and its subsequent development at the time of disease progression or relapse. RESULTS The most common sites for extramedullary disease at diagnosis were skin and soft tissue whereas liver involvement was the striking feature in extramedullary disease at disease relapse or progression. Regardless of therapy, extramedullary disease was associated with shorter progression-free and overall survival, as well as the presence of anemia, thrombocytopenia, elevated serum lactate dehydrogenase, cytogenetic abnormalities, and high-risk features in 70-and 80-gene risk models in univariate analysis. Multivariate analysis with logistic regression revealed that this disease feature was more prevalent in patients with an elevated centrosome index, as determined by gene expression profiling, as well as in myeloma molecular subtypes that are more prone to relapse. These include the MF subtype (also called the "MAF" subtype, associated with over-expression of the MAF gene seen with chromosome translocation 14;16 or 14;20) and the PR subtype (also called the "Proliferation" subtype, associated with overexpression of pro-proliferative genes). CONCLUSIONS These data show that extramedullary disease is more prevalent in genomically defined high-risk multiple myeloma and is associated with shorter progression-free survival and overall survival, even in the era of novel agents. All clinical trials included in the analyses were registered with www.clinicaltrials.gov (NCT00083551, NCT00083876, NCT00081939, NCT00572169, NCT00644228,NCT00002548,NCT00734877).
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Affiliation(s)
- Saad Z Usmani
- Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.
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308
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Saboo SS, Fennessy F, Benajiba L, Laubach J, Anderson KC, Richardson PG. Imaging features of extramedullary, relapsed, and refractory multiple myeloma involving the liver across treatment with cyclophosphamide, lenalidomide, bortezomib, and dexamethasone. J Clin Oncol 2012; 30:e175-9. [PMID: 22689802 DOI: 10.1200/jco.2011.41.1413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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309
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Abdominal manifestations of extraosseous myeloma: cross-sectional imaging spectrum. J Comput Assist Tomogr 2012; 36:207-12. [PMID: 22446361 DOI: 10.1097/rct.0b013e318245c261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Extraosseous myeloma, defined as the myelomatous involvement outside the skeleton system, is rare and often associated with advanced multiple myeloma. There has been a recent increase in the clinicoradiological incidence of this entity, possibly secondary to increased survival of patients and frequent use of imaging. This has led to the development of new clinical staging guidelines for multiple myeloma, which include the use of imaging modalities positron emission tomography/computed tomography and magnetic resonance imaging for accurate detection and optimal management. The aims of this review were to discuss the significance of identification of extraosseous disease, to describe the spectrum and common sites of extraosseous involvement in the abdomen, and to review the imaging findings of extraosseous myeloma in the abdomen.
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310
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Wirk B, Wingard JR, Moreb JS. Extramedullary disease in plasma cell myeloma: the iceberg phenomenon. Bone Marrow Transplant 2012; 48:10-8. [PMID: 22410751 DOI: 10.1038/bmt.2012.26] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Extramedullary (EM) plasmacytomas (EMPs) that are not progression of intramedullary (IM) plasma cell myeloma (PCM) are usually indolent. In contrast, EM spread of IM PCM is associated with a poor prognosis. The recently introduced Durie-Salmon PLUS staging system includes EM disease in the poor prognosis category. One study noted an increase in EM disease both at diagnosis and during follow-up of PCM in 2000-2007 compared with previous years raising concerns that adoption of novel agents (thalidomide, lenalidomide and bortezomib) and greater use of hematopoietic cell transplantation (HCT) might be contributory to this. It is uncertain if this is a true increase or merely greater detection due to the increasing use of more sensitive imaging techniques (computerized tomography, magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography) or a reflection of the evolving natural history of PCM in an era when patients are living longer (median overall survival before 1996 was 29.9 months vs 44.8 months after 1996). Recent studies suggest there are important biological differences between PCM with or without EM spread that are offering clues that might explain the propensity for dissemination and a more aggressive clinical course. For example, EM relapse in PCM with and without deletion 13 was 30.8 vs 5.6%, suggesting the biology of a plasma cell subclone before HCT can affect the nature of the relapse after HCT. This article will explore the clinical, biological and treatment implications of EM spread of PCM. In addition, the impact of extramedullary disease on the outcomes of autologous and allogeneic HCT for PCM will be analyzed. Allogeneic HCT early in the course of high-risk PCM with EM disease is a consideration since graft vs myeloma effects may be essential to achieve maximal survival benefits.
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Affiliation(s)
- B Wirk
- Bone Marrow Transplant Program, Division of Hematology-Oncology, University of Florida, Gainesville, FL 32610, USA.
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311
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Abstract
Effectively treating patients with multiple myeloma is challenging. The development of therapeutic regimens over the past decade that incorporate the proteasome inhibitor bortezomib and the immunomodulatory drugs thalidomide and lenalidomide has been the cornerstone of improving the outcome of patients with myeloma. Although these treatment regimens have improved patient survival, nearly all patients eventually relapse. Our improved understanding of the biology of the disease and the importance of the microenvironment has translated into ongoing work to help overcome the challenge of relapse. Several classes of agents including next-generation proteasome inhibitors, immunomodulatory agents, selective histone-deacetylase inhibitors, antibody and antitumor immunotherapy approaches are currently undergoing preclinical and clinical evaluation. This Review provides an update on the latest advances in the treatment of multiple myeloma. In particular, we focus on novel therapies including modulating protein homeostasis, kinases inhibitors, targeting accessory cells and cytokines, and immunomodulatory agents. A discussion of the challenges associated with these therapeutic approaches is also presented.
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312
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Features of extramedullary myeloma relapse: high proliferation, minimal marrow involvement, adverse cytogenetics: a retrospective single-center study of 24 cases. Ann Hematol 2012; 91:1031-7. [DOI: 10.1007/s00277-012-1414-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
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313
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Lin Y, Gertz MA. The role of phosphatase and tensin homolog deleted on chromosome 10 and focal adhesion kinase in aggressive multiple myeloma. Leuk Lymphoma 2012; 53:1021-2. [PMID: 22220917 DOI: 10.3109/10428194.2011.654340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yi Lin
- Mayo Clinic, Rochester, MN, USA.
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314
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Gangatharan SA, Carney DA, Prince HM, Wolf MM, Januszewicz EH, Ritchie DS, Harrison SJ. Emergence of central nervous system myeloma in the era of novel agents. Hematol Oncol 2011; 30:170-4. [DOI: 10.1002/hon.1021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 09/25/2011] [Accepted: 10/07/2011] [Indexed: 11/08/2022]
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315
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Abstract
Plasmacytoma is a tumor mass consisting of atypical plasma cells. Incidence of plasmacytomas associated with multiple myeloma range from 7% to 17% at diagnosis and from 6% to 20% during the course of the disease. In both situations, occurrence of extramedullary disease has been consistently associated with a poorer prognosis of myeloma. Extramedullary relapse or progression occurs in a variety of clinical circumstances and settings, and therefore requires individualization of treatment. Alkylating agents, bortezomib, and immunomodulatory drugs, along with corticoids, have been used to treat extramedullary relapse but, because of the relatively low frequency or detection rate of extramedullary relapse, no efficacy data are available from controlled studies in this setting.
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316
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Aguado B, Iñigo B, Sastre JL, Oriol A. Extramedullary plasmacytomas in the context of multiple myeloma. Adv Ther 2011; 28 Suppl 7:7-13. [PMID: 22105528 DOI: 10.1007/s12325-011-0073-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Indexed: 12/15/2022]
Abstract
Plasmacytoma is a frequent complication of multiple myeloma, either at diagnosis or within disease progression. The extramedullary disease confers a poorer prognosis and is biologically distinct with high-risk molecular and histological features, being resistant to conventional treatments. Radiation therapy remains the most effective treatment for extramedullary lesions to achieve local control. There are very limited data from randomized trials regarding the most appropriate systemic treatment. Case reports such as those presented here, as well as retrospective analysis of series, suggest that lenalidomide is an effective agent, in combination with dexamethasone, in this setting. Additional studies are needed to define the proper management of this condition.
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Affiliation(s)
- Beatriz Aguado
- Department of Hematology, Hospital Universitario de Princesa, Madrid, Spain
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317
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Bladé J, Fernández de Larrea C, Rosiñol L, Cibeira MT, Jiménez R, Powles R. Soft-Tissue Plasmacytomas in Multiple Myeloma: Incidence, Mechanisms of Extramedullary Spread, and Treatment Approach. J Clin Oncol 2011; 29:3805-12. [DOI: 10.1200/jco.2011.34.9290] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We provide an overview on soft-tissue extramedullary plasmacytomas (EMPs) in multiple myeloma (MM). We reviewed the incidence of EMPs in MM, myeloma bone marrow homing, possible mechanisms of extramedullary spread, and prognosis and response to therapy. The incidence of EMPs is 7% to 18% at MM diagnosis and up to 20% at relapse. The current notion that EMPs are more frequent after treatment with novel agents remains to be proven, especially considering that different patterns of disease recurrence can emerge as patients live longer in the era of novel drugs. Bone marrow genetic abnormalities are not associated with extramedullary spread per se, which also suggests that microenvironmental interactions are key. Possible mechanisms of extramedullary spread include decreased adhesion molecule expression and downregulation of chemokine receptors. EMPs usually show plasmablastic morphology with negative CD56 expression. High-dose therapy with autologous stem-cell transplantation (ASCT) can overcome the negative prognostic impact of extramedullary disease in younger selected patients. EMPs do not typically respond to thalidomide alone, but in contrast, responses to bortezomib have been reported. The incidence of EMPs in patients with MM is high and is associated with poor outcome in patients treated conventionally. A potential first-line treatment option seems to be a bortezomib-containing regimen followed by ASCT, whenever possible. Experimental studies on the mechanisms of myeloma cell adhesion, myeloma growth at extramedullary sites, and drug sensitivity are priorities for this area of continuing therapeutic challenge.
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Affiliation(s)
- Joan Bladé
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
| | - Carlos Fernández de Larrea
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
| | - Laura Rosiñol
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
| | - María Teresa Cibeira
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
| | - Raquel Jiménez
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
| | - Ray Powles
- Joan Bladé, Carlos Fernández de Larrea, Laura Rosiñol, María Teresa Cibeira, and Raquel Jiménez, Hospital Clínic and Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain; and Ray Powles, Parkside Cancer Centre, London, United Kingdom
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318
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Mettler TN, Holman CJ, McKenna RW, Pambuccian SE. Plasmablastic myeloma in ascitic fluid. Diagn Cytopathol 2011; 40:806-9. [PMID: 21698783 DOI: 10.1002/dc.21759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/21/2011] [Indexed: 11/05/2022]
Affiliation(s)
- Tetyana N Mettler
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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319
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Nakazato T, Mihara A, Ito C, Sanada Y, Aisa Y. Lenalidomide is active for extramedullary disease in refractory multiple myeloma. Ann Hematol 2011; 91:473-4. [DOI: 10.1007/s00277-011-1272-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/29/2011] [Indexed: 10/18/2022]
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320
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Short KD, Rajkumar SV, Larson D, Buadi F, Hayman S, Dispenzieri A, Gertz M, Kumar S, Mikhael J, Roy V, Kyle RA, Lacy MQ. Incidence of extramedullary disease in patients with multiple myeloma in the era of novel therapy, and the activity of pomalidomide on extramedullary myeloma. Leukemia 2011; 25:906-8. [PMID: 21350560 DOI: 10.1038/leu.2011.29] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We studied 174 consecutive patients with relapsed refractory multiple myeloma (MM) enrolled on a phase II clinical trial of pomalidomide plus low-dose dexamethasone at Mayo Clinic. Extramedullary disease (EMD) was present at the time of trial entry in 7.5% (13 of 174 patients). The rate of EMD in the first 3 years following diagnosis of MM was 3%. The response of EMD to pomalidomide plus low-dose dexamethasone included two complete and two partial responses among the 13 patients (response rate, 31%). Overall survival measured from trial entry was significantly shorter for patients with treatment-emergent EMD compared with those who did not have EMD, (median 16 months versus not reached, P=0.002).
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Affiliation(s)
- K Detweiler Short
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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321
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Haznedar R, Akı SZ, Akdemir ÖU, Özkurt ZN, Çeneli Ö, Yağcı M, Sucak GT, Ünlü M. Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging 2011; 38:1046-53. [DOI: 10.1007/s00259-011-1738-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 01/04/2011] [Indexed: 01/28/2023]
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322
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Paulus A, Swaika A, Miller KC, Spangenthal EJ, Guo R, VonFricken K, Lee K, Chanan-Khan AA. Clinical Relapse in a Patient With Multiple Myeloma Presenting As an Atrial Plasmacytoma. J Clin Oncol 2011; 29:e47-9. [DOI: 10.1200/jco.2010.30.3370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Kelvin Lee
- Roswell Park Cancer Institute, Buffalo, NY
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323
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Abstract
Multiple myeloma metastatic to the skin is a rare occurrence that usually reflects a high tumour burden. Here, we report the case of a woman with known multiple myeloma who developed cutaneous lesions on the right leg. Limited-field radiation treatment was successfully used to decrease her tumour bulk. Unfortunately, the patient died of complications related to systemic treatment a few months after developing the cutaneous involvement.
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Affiliation(s)
- S K A Nguyen
- Département de Radio-Oncologie, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Quebec City, QC
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324
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Abstract
OBJECTIVE A minority of patients with multiple myeloma have imaging findings of extraosseous involvement. Extraosseous myeloma may affect any organ and can mimic other malignancies. The objective of this article is to describe the clinical relevance of extraosseous myeloma and to present the diverse imaging findings of extraosseous myeloma. CONCLUSION The presence of radiologically detectable extraosseous myeloma is associated with a poor prognosis and thus is an important factor in the initial workup and follow-up evaluation.
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325
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De Larrea CF, Rosiñol L, Cibeira MT, Rozman M, Rovira M, Bladé J. Extensive soft-tissue involvement by plasmablastic myeloma arising from displaced humeral fractures. Eur J Haematol 2010; 85:448-51. [DOI: 10.1111/j.1600-0609.2010.01504.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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326
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van de Donk NWCJ, Lokhorst HM, Dimopoulos M, Cavo M, Morgan G, Einsele H, Kropff M, Schey S, Avet-Loiseau H, Ludwig H, Goldschmidt H, Sonneveld P, Johnsen HE, Bladé J, San-Miguel JF, Palumbo A. Treatment of relapsed and refractory multiple myeloma in the era of novel agents. Cancer Treat Rev 2010; 37:266-83. [PMID: 20863623 DOI: 10.1016/j.ctrv.2010.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/21/2010] [Accepted: 08/25/2010] [Indexed: 12/22/2022]
Abstract
The introduction of the Immunomodulatory drugs (IMiDs) and proteasome inhibitors, used either as a single-agent or combined with classic anti-myeloma therapies, has improved the outcome for patients with relapsed myeloma. However, there is currently no generally accepted standard treatment for relapsed/refractory myeloma patients, partly because of the absence of trials comparing the efficacy of the novel agents in relapsed/refractory myeloma. Choice of a new treatment regimen depends on both patient and disease-specific characteristics. A lenalidomide-based regimen is the first choice in patients with neuropathy, while bortezomib has the highest efficacy in patients with renal insufficiency and is not associated with increased risk of thromboembolism. A second autologous stem cell transplantation (auto-SCT) can be applied in patients with a progression-free period of ≥ 18-24 months after the first auto-SCT. In high-risk relapse such as occurring early after auto-SCT consolidation with allogeneic SCT can be considered. In this review we provide an overview of the various salvage regimens and give recommendations for treatment of patients with relapsed/refractory myeloma in different clinical settings.
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327
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Sher T, Miller KC, Deeb G, Lee K, Chanan-Khan A. Plasma cell leukaemia and other aggressive plasma cell malignancies. Br J Haematol 2010; 150:418-27. [PMID: 20701603 DOI: 10.1111/j.1365-2141.2010.08157.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Extramedullary plasma cell cancers, such as plasma cell leukaemia (PCL) and multiple extramedullary plasmacytomas (MEP) are very aggressive malignancies. These can be primary (de-novo) or secondary due to progressive prior multiple myeloma (MM). Recent reports suggest an increase in incidence of these disorders. Compared to MM, organ invasion is common in PCL, while soft tissue tumors involving the head, neck or paraspinal area are common sites for MEP. Markers of poor prognosis are frequently observed in these extramedullary forms of plasma cell cancers, and survival is significantly inferior compared to patients with MM. Conventional chemotherapeutic and radiotherapy approaches have been employed with variable results. Even high dose chemotherapy with autologous stem cell rescue has not been able to demonstrate consistent improvement in survival outcome. Although not specifically evaluated, novel anti-plasma cell agents, such as the proteasome inhibitor bortezomib, and immunomodulatory drugs, such as lenalidomide, appear to be active against these aggressive cancers. Clinical and translational research directed at improved understanding of disease biology and development of novel therapeutics is urgently needed.
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Affiliation(s)
- Taimur Sher
- Departments of Medicine, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA
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328
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Treatment of patients with relapsed/refractory multiple myeloma with lenalidomide and dexamethasone with or without bortezomib: prospective evaluation of the impact of cytogenetic abnormalities and of previous therapies. Leukemia 2010; 24:1769-78. [DOI: 10.1038/leu.2010.175] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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329
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Synovium tumor presenting as the first sign of IgD multiple myeloma. Ann Hematol 2010; 90:485-7. [PMID: 20690020 DOI: 10.1007/s00277-010-1035-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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330
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Weckbach S, Michaely HJ, Stemmer A, Schoenberg SO, Dinter DJ. Comparison of a new whole-body continuous-table-movement protocol versus a standard whole-body MR protocol for the assessment of multiple myeloma. Eur Radiol 2010; 20:2907-16. [PMID: 20574630 DOI: 10.1007/s00330-010-1865-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/11/2010] [Accepted: 05/19/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate a whole body (WB) continuous-table-movement (CTM) MR protocol for the assessment of multiple myeloma (MM) in comparison to a step-by-step WB protocol. METHODS Eighteen patients with MM were examined at 1.5T using a WB CTM protocol (axial T2-w fs BLADE, T1-w GRE sequence) and a step-by-step WB protocol including coronal/sagittal T1-w SE and STIR sequences as reference. Protocol time was assessed. Image quality, artefacts, liver/spleen assessability, and the ability to depict bone marrow lesions less than or greater than 1 cm as well as diffuse infiltration and soft tissue lesions were rated. Potential changes in the Durie and Salmon Plus stage and the detectability of complications were assessed. RESULTS Mean protocol time was 6:38 min (CTM) compared to 24:32 min (standard). Image quality was comparable. Artefacts were more prominent using the CTM protocol (P = 0.0039). Organ assessability was better using the CTM protocol (P < 0.001). Depiction of bone marrow and soft tissue lesions was identical without a staging shift. Vertebral fractures were not detected using the CTM protocol. CONCLUSIONS The new protocol allows a higher patient throughput and facilitates the depiction of extramedullary lesions. However, as long as vertebral fractures are not detectable, the protocol cannot be safely used for clinical routine without the acquisition of an additional sagittal sequence.
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Affiliation(s)
- S Weckbach
- Department of Clinical Radiology, University Hospital Munich-Grosshadern Campus, Marchioninistr. 15, 81377, Munich, Germany.
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331
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Weisser F, Reuter C, Taverna C. Extramedullary manifestations of multiple myeloma in the thyroid gland and in the lungs: excellent response to therapy. Ann Hematol 2010; 89:1183-4. [PMID: 20383503 PMCID: PMC2940024 DOI: 10.1007/s00277-010-0946-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Fabia Weisser
- Department of Internal Medicine, Medical Oncology, Kantonsspital Münsterlingen, Postfach, CH- 8596 Münsterlingen, Switzerland
| | - Christiane Reuter
- Department of Radiology, Radiation Oncology, Kantonsspital Münsterlingen, Postfach,, CH- 8596 Münsterlingen, Switzerland
| | - Christian Taverna
- Department of Internal Medicine, Medical Oncology, Kantonsspital Münsterlingen, Postfach, CH- 8596 Münsterlingen, Switzerland
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