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Gong Z, Khosla M, Vasudevan S, Mohan M. Current Status on Management of Primary Plasma Cell Leukemia. Curr Oncol Rep 2024; 26:1104-1112. [PMID: 38954316 DOI: 10.1007/s11912-024-01563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
PURPOSEOF REVIEW Plasma Cell Leukemia (PCL) is a very rare and highly aggressive form of plasma cell dyscrasia. This review seeks to evaluate the outcomes of PCL in the context of combination novel agent therapy and stem cell transplant (SCT) protocols. RECENT FINDINGS The diagnostic criteria for PCL have now evolved to include patients with 5% circulating PC. While management remains challenging, the incorporation of novel agent-based induction regimen has significantly improved early mortality and reduced attrition of patients proceeding to SCT. In recent prospective clinical trials, patients with PCL demonstrated an overall response rates of 69% to 86%, with progression-free and overall survival ranging from 13.8 to 15.5 months and 24.8 to 36.3 months, respectively. B-cell lymphoma 2 (BCL2) inhibitors, such as venetoclax present a targeted intervention opportunity for patients with PCL with t(11;14). Dedicated clinical trials tailored to PCL are crucial, integrating newer therapies in the frontline setting to further optimize responses and enhance overall outcomes.
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Affiliation(s)
- Zimu Gong
- Division of Hematology/Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Meera Khosla
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Sreeraj Vasudevan
- Department of Hematology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| | - Meera Mohan
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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2
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Zhao W, Chen L, Wang L, Wang W. Efficacy and Safety Analysis of VRD-PDCE in Treatment-Native Patients with Multiple Extramedullary Plasmacytomas or Plasma Cell Leukemia. Indian J Hematol Blood Transfus 2023; 39:383-391. [PMID: 37304491 PMCID: PMC10247585 DOI: 10.1007/s12288-022-01610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
The prognosis of multiple extramedullary plasmacytomas (MEP) and plasma cell leukemia (PCL) is extremely poor, with the median overall survival (OS) of only 8 months with standard chemotherapy. Innovative treatment approaches incorporating various strategies are required to improve outcome. From November 2019 to September 2021, a total of 12 newly diagnosed MEP or PCL patients were enrolled in our department. An intensive chemotherapy treatment as VRD-PDCE consisted of bortezomib, lenalidomide, dexamethasone plus cisplatin, pegylated liposomal doxorubicin, cyclophosphamide and etoposide was first proposed. Disease activity and toxicity were evaluated after each cycle. Of the patients receiving therapy achieved a rapid and sustained response, and the overall response rate (ORR) was up to 75%. Nine patients achieved partial response (PR) or better, the response was the best response and the median time to best response was 4 cycles. Median overall survival (OS) and progression-free survival (PFS) were 24 (5-30) months and 18 (2-23) months. The toxicities were acceptable and there was no treatment related mortality. Our intensive treatment showed encouraging results in terms of disease control and improving survival, VRD-PDCE may be a novel regimen which is feasible and generally well-tolerated in MEP or PCL patients.
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Affiliation(s)
- Weiwei Zhao
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Street, Nangang, Harbin, 150081 People’s Republic of China
| | - Liyan Chen
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Street, Nangang, Harbin, 150081 People’s Republic of China
| | - Lianjie Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Street, Nangang, Harbin, 150081 People’s Republic of China
| | - Wei Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, No.246 Xuefu Street, Nangang, Harbin, 150081 People’s Republic of China
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3
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Visram A, Suska A, Jurczyszyn A, Gonsalves WI. Practical management and assessment of primary plasma cell leukemia in the novel agent era. Cancer Treat Res Commun 2021; 28:100414. [PMID: 34174530 DOI: 10.1016/j.ctarc.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Visram
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - A Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - A Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - W I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States.
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4
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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5
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Yu T, Xu Y, An G, Tai YT, Ho M, Li Z, Deng S, Zou D, Yu Z, Hao M, Anderson KC, Qiu L. Primary Plasma Cell Leukemia: Real-World Retrospective Study of 46 Patients From a Single-Center Study in China. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e652-e659. [PMID: 32624447 DOI: 10.1016/j.clml.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary plasma cell leukemia (PPCL) is a rare and aggressive plasma cell disorder. The use of novel agents, together with autologous stem cell transplantation, has improved survival outcome in PPCL. However, the prognosis is still very poor, and the optimal treatment remains an unmet clinical need. PATIENTS AND METHODS We studied the efficacy and prognostic impact of novel agents in 46 patients with PPCL patients at the Blood Diseases Hospital in China. We examined the impact of clinical and laboratory features, as well as therapies (bortezomib- and/or immunomodulatory drug-based therapies, chemotherapy) on survival and extent of clinical response, including progression-free survival and overall survival (OS). Progression-free survival and OS were assessed by the Kaplan-Meier method, and survival distributions were compared by log-rank test. RESULTS In our cohort of 46 PPCL patients, the median age at the time of diagnosis was 54 years. Overall response rate was 54% (25/46). The median (95% confidence interval) progression-free survival time was 6 (0-12.5) months, and OS time was 14 (4.6-23.4) months. The OS time was significantly longer in patients treated with bortezomib-based versus non-bortezomib-based therapies (median [95% confidence interval], 19 [9-28.9] vs. 5 [4-24] months; P = .019). CONCLUSION This large single-center study of PPCL supports the use of bortezomib-based therapies as frontline treatment in PPCL patients.
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Affiliation(s)
- Tengteng Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yu-Tzu Tai
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew Ho
- UCD School of Medicine, College of Health and Agricultural Science and UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Zengjun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhen Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
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6
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Galakhoff N, Leven C, Eveillard JR, Tempescul A, Kerspern H, Aubron C, Buors C, Lippert É, Carré JL, Padelli M. A case of IgE myeloma transformed into IgE-producing plasma cell leukaemia. Biochem Med (Zagreb) 2019; 30:010801. [PMID: 31839726 PMCID: PMC6904968 DOI: 10.11613/bm.2020.010801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/07/2019] [Indexed: 01/22/2023] Open
Abstract
This is a case report of a challenging diagnosis of IgE monoclonal gammopathy of undetermined significance, which transformed into myeloma, then transformed into IgE-producing plasma cell leukaemia in a 71-year-old male who was followed in Brest, France, from 2015 to 2019. The IgE-producing variant is the rarest sub-type of multiple myeloma, and plasma cell leukaemia is considered to be the rarest and the most aggressive of human monoclonal gammopathies. In November 2015, hypogammaglobulinemia was detected during a systematic check-up. A kappa light chain monoclonal gammopathy was first diagnosed due to an increase of the free kappa/lambda light chains ratio. No monoclonal immunoglobulin was detected by either serum protein electrophoresis (Capillarys 2, Sebia, Issy-les-Moulineaux, France) or immunofixation (Hydrasys 2, Sebia, Issy-les-Moulineaux, France). In June 2018, a blood smear led to the diagnosis of plasma cell leukaemia. A monoclonal peak was detected and identified as IgE-kappa. Analysis of an archival sample taken three years earlier, revealed the presence of a monoclonal IgE, which had been missed at diagnosis. Chemotherapy with bortezomib and dexamethasone was introduced. The patient survived 10 months after the diagnosis of leukaemia. This case shows that an abnormal free light chain ratio should be considered as a possible marker of IgE monoclonal gammopathy even in the absence of a solitary light chain revealed by immunofixation. In addition, the use of an undiluted serum may increase the sensitivity of the immunofixation for the detection of IgE monoclonal gammopathies compared to the 1:3 dilution recommended by the manufacturer.
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Affiliation(s)
- Nicolas Galakhoff
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
| | - Cyril Leven
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
| | | | - Adrian Tempescul
- Department of Haematology, Brest University Hospital, Brest, France
| | - Hélène Kerspern
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
| | - Cécile Aubron
- Medical Intensive Care, Brest University Hospital, Brest, France
| | - Caroline Buors
- Laboratory of Haematology, Brest University Hospital, Brest, France
| | - Éric Lippert
- Laboratory of Haematology, Brest University Hospital, Brest, France.,Université de Brest, INSERM, EFS, UMR 1078, GGB, Brest, France
| | - Jean-Luc Carré
- Department of Biochemistry and Pharmaco-Toxicology, Brest University Hospital, Brest, France
| | - Maël Padelli
- Department of Biochemistry and Pharmaco-Toxicology, Martinique University Hospital, Fort-de-France, France
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7
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Jurczyszyn A, Castillo JJ, Avivi I, Czepiel J, Davila J, Vij R, Fiala MA, Gozzetti A, Grząśko N, Milunovic V, Hus I, Mądry K, Waszczuk-Gajda A, Usnarska-Zubkiewicz L, Dębski J, Atilla E, Beksac M, Mele G, Sawicki W, Jayabalan D, Charliński G, Gyula Szabo A, Hajek R, Delforge M, Kopacz A, Fantl D, Waage A, Crusoe E, Hungria V, Richardson P, Laubach J, Guerrero-Garcia T, Liu J, Vesole DH. Secondary plasma cell leukemia: a multicenter retrospective study of 101 patients. Leuk Lymphoma 2018; 60:118-123. [DOI: 10.1080/10428194.2018.1473574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Artur Jurczyszyn
- Hematology Department, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge J. Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Irit Avivi
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - Julio Davila
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ravi Vij
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mark A. Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Norbert Grząśko
- Department of Hematology, St John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematology, Medical University of Lublin, Lublin, Poland
| | - Vibor Milunovic
- Division of Hematology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Iwona Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dębski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Erden Atilla
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | - Meral Beksac
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | | | - Waldemar Sawicki
- Department of Internal Medicine and Hematology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Roman Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | | | - Dorotea Fantl
- Seccion Hematologia Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anders Waage
- Norwegian University of Science and Technology, St. Olav’s Hospital, Trondheim, Norway
| | - Edvan Crusoe
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Vania Hungria
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jacob Laubach
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Guerrero-Garcia
- Division of Hematology and Oncology, Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, Brighton, MA, USA
| | - Jieqi Liu
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David H. Vesole
- John Theurer Cancer Center, Myeloma Division, Hackensack University Medical Center, Hackensack, NJ, USA
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8
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Jurczyszyn A, Radocha J, Davila J, Fiala MA, Gozzetti A, Grząśko N, Robak P, Hus I, Waszczuk-Gajda A, Guzicka-Kazimierczak R, Atilla E, Mele G, Sawicki W, Jayabalan DS, Charliński G, Szabo AG, Hajek R, Delforge M, Kopacz A, Fantl D, Waage A, Avivi I, Rodzaj M, Leleu X, Richez V, Knopińska-Posłuszny W, Masternak A, Yee AJ, Barchnicka A, Druzd-Sitek A, Guerrero-Garcia T, Liu J, Vesole DH, Castillo JJ. Prognostic indicators in primary plasma cell leukaemia: a multicentre retrospective study of 117 patients. Br J Haematol 2018; 180:831-839. [PMID: 29315478 DOI: 10.1111/bjh.15092] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
We report a multicentre retrospective study that analysed clinical characteristics and outcomes in 117 patients with primary plasma cell leukaemia (pPCL) treated at the participating institutions between January 2006 and December 2016. The median age at the time of pPCL diagnosis was 61 years. Ninety-eight patients were treated with novel agents, with an overall response rate of 78%. Fifty-five patients (64%) patients underwent upfront autologous stem cell transplantation (ASCT). The median follow-up time was 50 months (95% confidence interval [CI] 33; 76), with a median overall survival (OS) for the entire group of 23 months (95% CI 15; 34). The median OS time in patients who underwent upfront ASCT was 35 months (95% CI 24·3; 46) as compared to 13 months (95% CI 6·3; 35·8) in patients who did not receive ASCT (P = 0·001). Multivariate analyses identified age ≥60 years, platelet count ≤100 × 109 /l and peripheral blood plasma cell count ≥20 × 109 /l as independent predictors of worse survival. The median OS in patients with 0, 1 or 2-3 of these risk factors was 46, 27 and 12 months, respectively (P < 0·001). Our findings support the use of novel agents and ASCT as frontline treatment in patients with pPCL. The constructed prognostic score should be independently validated.
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Affiliation(s)
| | - Jakub Radocha
- 4th Department of Medicine - Haematology, Charles University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Julio Davila
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Mark A Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Norbert Grząśko
- Department of Haematology, St John's Cancer Centre, Lublin, Poland.,Department of Experimental Haematology, Medical University of Lublin, Lublin, Poland
| | - Paweł Robak
- Department of Haematology, Medical University of Lodz, Copernicus Memorial Hospital, Łódź, Poland
| | - Iwona Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | | | - Erden Atilla
- Haematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | | | - Waldemar Sawicki
- Dept. of Internal Medicine and Haematology, Military Institute of Medicine, Warsaw, Poland
| | | | | | - Agoston G Szabo
- Department of Medicine, Section of Haematology, Vejle, Denmark
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Agnieszka Kopacz
- Department of Haematology, University of Rzeszów, Rzeszów, Poland
| | - Dorotea Fantl
- Seccion Hematologia Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anders Waage
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Irit Avivi
- Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Marek Rodzaj
- Department of Haematology, State Hospital, Cracow, Poland
| | - Xavier Leleu
- Service d'Hematologie CHU, Hopital de la Miletrie, Poitiers, France
| | - Valentine Richez
- Ministry of Interior Hospital in Olsztyn with Warmia and Masuria Oncology Centre, Olsztyn, Poland
| | | | - Anna Masternak
- Department of Haematology, State Hospital, Opole, Poland
| | - Andrew J Yee
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Agnieszka Barchnicka
- Department of Doctoral Studies, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | | | - Thomas Guerrero-Garcia
- Division of Hematology and Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Brighton, MA, USA
| | - Jieqi Liu
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David H Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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9
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Wong P, Kashtwari D, Nair MK. Radiographic features of plasma cell leukemia in the maxilla: A case report. Imaging Sci Dent 2016; 46:273-278. [PMID: 28035306 PMCID: PMC5192026 DOI: 10.5624/isd.2016.46.4.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/06/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive form of multiple myeloma where there is hematogenous spread of abnormal plasma cells into the periphery. This is opposed to multiple myeloma, where the abnormal plasma cells stay in the bone marrow. PCL is more common in males than females, and is also more common in African-Americans than Caucasians. Signs and symptoms of PCL include, but are not limited to, renal insufficiency, hypercalcemia, anemia, lytic bone lesions, thrombocytopenia, hepatomegaly, and splenomegaly. Here, we discussed a case of a 71-year-old Caucasian female recently diagnosed with primary PCL with radiographic features of this disease throughout the body, with an emphasis on the maxillofacial skeleton and relevance from a dental standpoint.
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Affiliation(s)
- Phillip Wong
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
| | - Deeba Kashtwari
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
| | - Madhu K Nair
- Division of Oral and Maxillofacial Radiology, Oral and Maxillofacial Diagnostic Sciences/Radiology, Colleges of Dentistry/Medicine, University of Florida, Gainesville, FL, USA
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10
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Mina R, D’Agostino M, Cerrato C, Gay F, Palumbo A. Plasma cell leukemia: update on biology and therapy. Leuk Lymphoma 2016; 58:1538-1547. [DOI: 10.1080/10428194.2016.1250263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Roberto Mina
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Mattia D’Agostino
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Chiara Cerrato
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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11
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Pichardo Rodríguez R, Ruiz Franco O, Rojas Llana J, Romero Aponte B. Dolor de la región lumbar como presentación de leucemia de células plasmáticas primaria avanzada con marcadores de mal pronóstico. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n2.47457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>La leucemia de células plasmáticas es una entidad rara que representa el 1-2% del total de las neoplasia hematológicas; es una enfermedad agresiva con mala respuesta al tratamiento y un promedio de sobrevida de siete meses. Se presenta el caso de una paciente diagnosticada con leucemia de células plasmáticas primaria con marcadores de mal pronóstico y tratamiento, quien tuvo como manifestación clínica inicial dolor lumbar, el cual evoluciono desfavorablemente y con desenlace fatal.Abstract Plasma cell leukemia is a rare disease that accounts for 1-2% of all hematologic neoplasia. It is an aggressive disease with poor response to treatment and an average survival period of seven months. The case of a patient diagnosed with advanced primary plasma cell leukemia with markers of poor prognosis and treatment whose first symptom was back pain, which did not evolve in a positive way and ended in the death of the patient.</p>
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13
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Plasma cell leukaemia masquerading as hairy cell leukaemia: a case report. Indian J Hematol Blood Transfus 2014; 30:33-5. [PMID: 25332528 DOI: 10.1007/s12288-013-0228-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022] Open
Abstract
Plasma cell leukaemia is a rare and aggressive neoplasm with survival of less than one year with conventional treatment. It can rarely present with morphology mimicking hairy cell leukaemia. We present a case of plasma cell leukaemia with hairy cell morphology for its rarity, diagnostic difficulty and aggressive course.
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Jimenez-Zepeda VH, Reece DE, Trudel S, Chen C, Tiedemann R, Kukreti V. Lenalidomide (Revlimid), bortezomib (Velcade) and dexamethasone for the treatment of secondary plasma cell leukemia. Leuk Lymphoma 2014; 56:232-5. [DOI: 10.3109/10428194.2014.893304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Bidmos MA, Joubert S, van Jaarsveld MFPC, Louw VJ. Plasma cell leukaemia and HIV co-infection: profile of patients and experience at Universitas Academic Hospital in Bloemfontein, South Africa. Int J Hematol 2013; 98:672-80. [PMID: 24258709 DOI: 10.1007/s12185-013-1461-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
Plasma cell leukaemia (PCL) is a rare condition with high mortality. HIV-positive patients have a propensity to develop malignancy; however, the occurrence of PCL with HIV infection in South Africa has not been documented. We describe patients with PCL in Universitas Hospital in Bloemfontein, South Africa, and report two new cases of HIV infection concurrent with PCL. A retrospective case series of PCL patients (2006-2012) seen at our Clinical Haematology unit is reported. Patient files were used to obtain information. The median age of patients (n = 9) was 51 years, and 66.7 % of cases were of African ethnicity. The condition was equally distributed between genders. Two patients were HIV positive. Both received combination antiretroviral therapy. The diagnosis of PCL was usually made as an incidental finding, subsequently confirmed on bone marrow aspirate and trephine. Deranged haematological and biochemical parameters, including severe anaemia, hypoalbuminaemia, and hyper-cellular bone marrow, were observed. Only one patient improved markedly on treatment, and remains alive at the time of writing. PCL shows poor response to treatment and predominates among Africans. The small sample size made it difficult to determine whether co-infection with HIV was a coincidental finding or the two diseases are pathophysiologically linked.
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Affiliation(s)
- Mubarak Ariyo Bidmos
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Canada,
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16
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Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell proliferative disorder with a very poor prognosis and with distinct biologic, clinical, and laboratory features. Compared with multiple myeloma, pPCL presents more often with extramedullary involvement, anemia, thrombocytopenia, hypercalcemia, elevated serum β(2)-microglobulin and lactate dehydrogenase levels, as well as impaired renal function. Many of the genetic aberrations observed in newly diagnosed pPCL are typically found in advanced multiple myeloma. These cytogenetic abnormalities and mutations lead to increased proliferation, enhanced inhibition of apoptosis, escape from immune surveillance, and independence from the BM microenvironment, with changes in expression of adhesion molecules or chemokine receptors. The outcome of pPCL has improved with the introduction of autologous stem cell transplantation and combination approaches with novel agents, including bortezomib and immunomodulatory drugs, such as lenalidomide. In this review, we provide an overview of currently available therapeutic options with recommendations of how these treatment modalities can best be used to improve outcome for plasma cell leukemia patients.
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17
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Ozasa R, Hotta M, Yoshimura H, Nakanishi T, Tamaki T, Fujita S, Nakamichi N, Miyaji M, Ishii K, Ito T, Nomura S. Therapeutic effect of bortezomib for primary plasma cell leukemia followed by auto/allo stem cell transplantation. Int Med Case Rep J 2012; 5:39-43. [PMID: 23754921 PMCID: PMC3658252 DOI: 10.2147/imcrj.s33293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare disease that represents approximately 4% of plasma cell malignant disorders. PCL consists of two variants: primary PCL presents in patients with no previous history of multiple myeloma, while secondary PCL consists of a leukemic transformation in a previously recognized multiple myeloma. Primary PCL is an extremely resistant, rapidly progressive, fatal disease, with a median overall survival of 6.8 months. There is no standard therapeutic strategy, because no treatment option has been prospectively evaluated. We describe a successful case of newly diagnosed primary PCL, treated with a regimen that included bortezomib, followed by auto stem cell transplantation and nonmyeloablative allogeneic stem cell transplantation. Our patient has maintained remission status for over 12 months since undergoing the allogeneic stem cell transplantation. This strategy is promising for PCL, which, though an extremely resistant disease, may become curable.
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Affiliation(s)
- Ryotaro Ozasa
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
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18
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D'Arena G, Valentini CG, Pietrantuono G, Guariglia R, Martorelli MC, Mansueto G, Villani O, Onofrillo D, Falcone A, Specchia G, Semenzato G, Di Renzo N, Mastrullo L, Venditti A, Ferrara F, Palumbo A, Pagano L, Musto P. Frontline chemotherapy with bortezomib-containing combinations improves response rate and survival in primary plasma cell leukemia: a retrospective study from GIMEMA Multiple Myeloma Working Party. Ann Oncol 2011; 23:1499-502. [PMID: 22039089 DOI: 10.1093/annonc/mdr480] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The best therapeutic approach for primary plasma cell leukemia (PPCL) remains unknown so far. In very limited studies, the poor clinical outcome of this aggressive variant of multiple myeloma seemed to be ameliorated by the use of the proteasome inhibitor bortezomib. Aiming to provide more consolidated data, this multicenter retrospective survey focused on unselected and previously untreated PPCL patients who had received bortezomib as frontline therapy. PATIENTS AND METHODS Twenty-nine patients with PPCL were collected. Bortezomib was given at standard doses and schedules, in various combinations with dexamethasone, thalidomide, doxorubicin, melphalan, prednisone, vincristine, and cyclophosphamide. RESULTS An overall response rate of 79% was observed, with 38% of at least very good partial remission. Grade 3-4 hematological, neurological, infectious, and renal toxic effects occurred in 20%, 21%, 16%, and 4% of patients, respectively. After a median follow-up of 24 months, 16 patients were alive (55%), 12 of whom were in remission phase and 4 relapsed. The best long-term results were achieved in patients who received stem-cell transplantation after bortezomib induction. CONCLUSION Bortezomib, used as initial therapy, is able to increase the percentage and the quality of responses in PPCL patients, producing a significant improvement of survival.
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Affiliation(s)
- G D'Arena
- Onco-Hematology Department, Istituto di Ricovero e Cura a carattere Scientifico, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture
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19
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Jimenez-Zepeda VH, Neme-Yunes Y, Braggio E. Chromosome abnormalities defined by conventional cytogenetics in plasma cell leukemia: what have we learned about its biology? Eur J Haematol 2011; 87:20-7. [PMID: 21692850 DOI: 10.1111/j.1600-0609.2011.01629.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cancer cells are characterized by having chromosomal abnormalities. The number of aberrations and the specific chromosomes affected are likely correlated with tumor progression. In this study, we analyzed the karyotype of 126 plasma cell leukemia (PCL) patients to identify the most frequently occurring imbalances and to design a model of karyotypic evolution. The Mitelman database of chromosome was searched and abnormal karyotypes were assessed. The main clones were analyzed and chromosomal gains and losses were used to design a model of genetic acquisition based on the calculation of a variable called time to occurrence. Our comprehensive study of genetic abnormalities of a large number of PCL karyotypes suggests that PCL is mainly characterized by the presence of whole chromosome losses as well as IgH rearrangements which is similar to that observed in non-hyperdiploid multiple myeloma (MM). Temporal analysis suggests that most PCL have around 10 abnormalities at diagnosis. It is possible that accumulation of abnormalities such as 17p13 (TP53) and 1p losses may trigger the extramedullary features of PCL. Our study demonstrates that cytogenetics is a valuable tool to evaluate the role of genetic imbalances on karyotypic evolution by using a mathematical model.
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Musto P, Pagano L, Petrucci MT, Morabito F, Caravita T, Di Raimondo F, Baldini L, Tosi P, Bringhen S, Offidani M, Omede' P, Neri A, D'Auria F, Bochicchio GB, Cavo M, Boccadoro M, Palumbo A. Primary plasma cell leukemia in the era of new drugs: has something changed? Crit Rev Oncol Hematol 2011; 82:141-9. [PMID: 21719304 DOI: 10.1016/j.critrevonc.2011.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/20/2011] [Accepted: 04/14/2011] [Indexed: 12/16/2022] Open
Abstract
Primary plasma cell leukemia (PPCL) is a rare and aggressive variant of multiple myeloma. This disease is associated with a very poor prognosis, and unfortunately it has not significantly improved during the last three decades. Autologous stem cell transplantation is generally recommended in eligible patients, but survival in transplanted PPCL patients is significantly lower than that of multiple myeloma. Recent preliminary data indicate that new drugs, in particular lenalidomide and bortezomib, could significantly improve the clinical outcome of PPCL, increasing response rate and duration, as well as survival. In this review we report an updated literature analysis about the current therapeutic scenario of PPCL, with a particular focus on the use of novel agents.
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Affiliation(s)
- Pellegrino Musto
- Department of Onco-Hematology, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy. ,
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21
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Abstract
Plasma cell leukemia (PCL) is a rare, yet aggressive plasma cell (PC) neoplasm, variant of multiple myeloma (MM), characterized by high levels of PCs circulating in the peripheral blood. PCL can either originate de novo (primary PCL) or as a secondary leukemic transformation of MM (secondary PCL). Presenting signs and symptoms are similar to those seen in MM such as renal insufficiency, hypercalcemia, lytic bone lesions, anemia, and thrombocytopenia, but can also include hepatomegaly and splenomegaly. The diagnostic evaluation of a patient with suspected PCL should include a review of the peripheral blood smear, bone marrow aspiration and biopsy, serum protein electrophoresis (SPEP) with immunofixation, and protein electrophoresis of an aliquot from a 24h urine collection (UPEP). The diagnosis is made when a monoclonal population of PCs is present in the peripheral blood with an absolute PC count exceeding 2000/μL and PC comprising 20% or more of the peripheral blood white cells. The prognosis of PCL is poor with a median survival of 7 to 11 months. Survival is even shorter (2 to 7 months) when PCL occurs in the context of refractory or relapsing MM. There have been no prospective randomized trials investigating the treatment of PCL. Recommendations are primarily based upon data from small retrospective series, case reports, and extrapolation of data from patients with MM. In general, patients are treated with induction therapy followed by hematopoietic cell transplantation (HCT) in those who are appropriate candidates for this approach. The best induction regimen for PCL is not known and there is great variability in clinical practice. Newer agents that are being incorporated into frontline and salvage therapy for MM have also demonstrated activity in PCL such as Immunomodulatory agents and the use of bortezomib with different combinations.
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22
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Pagano L, Valentini CG, De Stefano V, Venditti A, Visani G, Petrucci MT, Candoni A, Specchia G, Visco C, Pogliani EM, Ferrara F, Galieni P, Gozzetti A, Fianchi L, De Muro M, Leone G, Musto P, Pulsoni A. Primary plasma cell leukemia: a retrospective multicenter study of 73 patients. Ann Oncol 2011; 22:1628-1635. [PMID: 21252060 DOI: 10.1093/annonc/mdq646] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Epidemiological and clinical information on primary plasma cell leukemia (pPCL) are rarely reported. The aims are to evaluate the clinical features, prognostic factors, and efficacy of treatments in pPCL. PATIENTS AND METHODS A multicenter retrospective cohort study was carried out from January 2000 to December 2008 in 26 Italian hematology divisions. A total of 128 cases of plasma cell leukemia were collected, and 73 of them (57%) were classified as primary (male/female 43/30). RESULTS Sixty-four patients had at least 1 sign of end-organ damage and 10 had extramedullary localization. One patient died early; of the remaining patients, 36 (50%) received anthracycline-based regimens as first-line therapy, 17 (24%) single alkylating agents, and 30 (42%) bortezomib or thalidomide as additional (n = 11) or unique treatments (n = 19). Twenty-three patients (31%) underwent autologous and/or allogeneic hematopoietic stem cell transplantation (HSCT). The median overall survival (OS) was 12.6 months; complete or partial response was achieved in 22 (30%) and 18 patients (25%), respectively; the median duration of response (DOR) was 16.4 months. HSCT patients had a longer OS and DOR (median 38.1 and 25.8 months, respectively) compared with nontransplanted patients (9.1 and 7.3 months, respectively, P < 0.001). OS was influenced by nonresponse to treatment, hypoalbuminemia, and HSCT. DOR was favorably influenced only by HSCT. CONCLUSIONS pPCL is an aggressive disease with a poor prognosis and a low response rate to conventional therapy. HSCT is effective, increasing OS and DOR by 69% and 88%, respectively. The use of bortezomib and thalidomide may improve outcomes.
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Affiliation(s)
- L Pagano
- Institute of Hematology, Catholic University, Rome.
| | | | - V De Stefano
- Institute of Hematology, Catholic University, Rome
| | - A Venditti
- Division of Hematology, "Tor Vergata" University, Rome
| | - G Visani
- Hematology and Hematopoietic Stem Cell Transplant Center, San Salvatore Hospital, Pesaro
| | - M T Petrucci
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University "La Sapienza," Rome
| | - A Candoni
- Division of Hematology and Bone Marrow Transplantation, University of Udine, Udine
| | - G Specchia
- Hematology Section, University of Bari, Bari
| | - C Visco
- Department of Hematology, Ospedale San Bortolo, Vicenza
| | - E M Pogliani
- Department of Hematology, "San Gerardo" Hospital, Monza
| | - F Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples
| | - P Galieni
- Division of Hematology, Ascoli Piceno Hospital, Ascoli Piceno
| | - A Gozzetti
- Department of Medicine and Immunological Sciences, Division of Hematology and Transplants, University of Siena, Siena
| | - L Fianchi
- Institute of Hematology, Catholic University, Rome
| | - M De Muro
- Division of Hematology, Campus Biomedico University, Rome
| | - G Leone
- Institute of Hematology, Catholic University, Rome
| | - P Musto
- Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Rionero in Vulture, Italy
| | - A Pulsoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, University "La Sapienza," Rome
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23
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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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24
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Capalbo S, Chiefa A, Delia M, Diomede D, Liso V. Effective combination therapy of bortezomib and dexamethasone for a plasma cell leukemia patient with multiple osteolytic lesions and extramedullary involvement. Acta Oncol 2009; 46:262-4. [PMID: 17453381 DOI: 10.1080/02841860600897975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Ali R, Beksac M, Ozkalemkas F, Ozkocaman V, Ozkan A, Ozcelik T, Tunali A. Efficacy of bortezomib in combination chemotherapy on secondary plasma cell leukemia. Leuk Lymphoma 2009; 48:1426-8. [PMID: 17613776 DOI: 10.1080/10428190701370597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Plasma cell leukemia: a highly aggressive monoclonal gammopathy with a very poor prognosis. Int J Hematol 2009; 89:259-268. [PMID: 19326058 DOI: 10.1007/s12185-009-0288-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 01/27/2009] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
Abstract
Plasma cell leukemia (PCL) is an aggressive variant of multiple myeloma and is characterized by the presence of >20% and/or an absolute number of greater 2 x 10(9)/L plasma cells circulating in the peripheral blood. PCL represents approximately 2-4% of all MM diagnosis and exists in two forms: primary PCL (PPCL, 60% of cases) presents de novo, whereas secondary PCL (SPCL, accounts for the remaining 40%) consists of a leukemic transformation in patients with a previously diagnosed MM. Because the mechanisms contributing to the pathogenesis of PCL are not fully understood, immunophenotyping, genetic evaluation (conventional karyotype, FISH, GEP and array-CGH), and immunohistochemistry are really important tools to investigate why plasma cells escape from bone marrow and become highly aggressive. Since treatment with standard agents and steroids is poorly effective, a combination of new drugs as part of the induction regimens and bone marrow transplant (autologous and allogeneic approaches) could nearly overcome the poor prognosis exhibited by PCL patients.
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27
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Chan SM, George T, Cherry AM, Medeiros BC. Complete remission of primary plasma cell leukemia with bortezomib, doxorubicin, and dexamethasone: a case report. CASES JOURNAL 2009; 2:121. [PMID: 19192311 PMCID: PMC2644294 DOI: 10.1186/1757-1626-2-121] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 02/04/2009] [Indexed: 11/10/2022]
Abstract
Background Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder considered to be a variant of multiple myeloma. It is an aggressive disease with a poor clinical response to standard chemotherapeutic agents. Case presentation A novel regimen consisting of bortezomib, doxorubicin, and dexamethasone is currently under active evaluation for the treatment of multiple myeloma. We employed this combination as front-line chemoinduction therapy for a case of primary PCL. Conclusion Complete remission was achieved with rapid normalization of hematologic parameters. The combination of bortezomib, doxorubicin and dexamethasone demonstrates promise in the treatment of PCL.
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Affiliation(s)
- Steven M Chan
- Division of Hematology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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28
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Yotsumoto M, Ichikawa N, Ueno M, Higuchi Y, Asano N, Kobayashi H. CD20-negative CD138-positive leukemic large cell lymphoma with plasmablastic differentiation with an IgH/MYC translocation in an HIV-positive patient. Intern Med 2009; 48:559-62. [PMID: 19336959 DOI: 10.2169/internalmedicine.48.1359] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 49-year-old HIV-positive Japanese man was referred to our hospital for multiple skin nodules. Many plasmablastic atypical lymphocytes were observed in the peripheral blood. He was diagnosed with diffuse large B cell lymphoma (DLBCL) by a biopsy of the inguinal lymph node. IgH/MYC translocation was detected by in situ hybridization of the lymph node and chromosomal analysis of bone marrow cells showed 46, XY, t(8 ; 14)(q24 ; q32)add(14)(q32), der(21)t(1 ; 21)(q12 ; p11). He showed a transient response to multi-agent chemotherapy, and during the course of salvage chemotherapy, he died of urinary infection. This case has unique clinical features compared with previously reported DLBCLs with plasmablastic differentiation.
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MESH Headings
- Antigens, Neoplasm/analysis
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Cytomegalovirus Retinitis/complications
- Cytomegalovirus Retinitis/drug therapy
- Dexamethasone/administration & dosage
- Doxorubicin/administration & dosage
- Epstein-Barr Virus Infections/diagnosis
- Fatal Outcome
- Ganciclovir/therapeutic use
- Genes, myc
- Humans
- Immunoglobulin Heavy Chains/genetics
- Lymph Nodes/pathology
- Lymphoma, AIDS-Related/chemistry
- Lymphoma, AIDS-Related/drug therapy
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/virology
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Middle Aged
- Salvage Therapy
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Syndecan-1/analysis
- Translocation, Genetic
- Urinary Tract Infections/complications
- Vincristine/administration & dosage
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29
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Martín-Ayuso M, Almeida J, Pérez-Andrés M, Cuello R, Galende J, González-Fraile MI, Martín-Nuñez G, Ortega F, Rodríguez MJ, San Miguel JF, Orfao A. Peripheral blood dendritic cell subsets from patients with monoclonal gammopathies show an abnormal distribution and are functionally impaired. Oncologist 2008; 13:82-92. [PMID: 18245015 DOI: 10.1634/theoncologist.2007-0127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objectives. The information currently available about dendritic cells (DCs) in patients with different types of monoclonal gammopathy (MG) is limited and frequently controversial. In the present study, we analyzed the ex vivo distribution as well as the phenotypic and functional characteristics of peripheral blood (PB) DCs from different types of MG. Methods. For this purpose, 61 untreated patients in total with MG were analyzed-MG of undetermined significance (MGUS), 29 cases; multiple myeloma (MM), 28 cases; and plasma cell leukemia (PCL), 4 cases-in comparison with a group of 10 healthy controls. Results. Our results show an absolute overall higher number of all subsets of PB DCs in PCL, together with lower numbers of myeloid DCs in MM patients. From a phenotypic point of view, PB DC subsets from all types of MG expressed significantly higher levels of HLA molecules and altered patterns of expression of the CD2, CD11c, CD16, CD22, CD62L, and CD86 molecules, in association with altered patterns of secretion of inflammatory cytokines. Conclusion. In summary, we show the existence of significant abnormalities in the distribution, phenotype, and pattern of secretion of inflammatory cytokines by different subsets of PB DCs from patients with MGs, which could reflect a potentially altered homing of DCs, together with a greater in vivo activation and lower responsiveness of PB DCs, which are already detectable in MGUS patients.
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Affiliation(s)
- Marta Martín-Ayuso
- Servicio de Citometría & Departamento de Medicina, University of Salamanca, Salamanca, Spain
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Musto P, Rossini F, Gay F, Pitini V, Guglielmelli T, D'Arena G, Ferrara F, Filardi N, Guariglia R, Palumbo A. Efficacy and safety of bortezomib in patients with plasma cell leukemia. Cancer 2007; 109:2285-90. [PMID: 17469169 DOI: 10.1002/cncr.22700] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prognosis of patients with plasma cell leukemia (PCL), an aggressive variant of multiple myeloma (MM), is usually poor. Bortezomib is the first proteasome inhibitor approved for the treatment of advanced MM. Currently available information regarding the role of bortezomib in PCL is scanty and derives from anecdotal, single-case reports. METHODS The authors conducted a retrospective survey of unselected Italian patients with primary or secondary PCL who were treated with bortezomib outside of clinical trials. Twelve evaluable patients were recorded who had received bortezomib for 1 to 6 cycles as either a single agent or variously combined with other drugs. Three patients were treated with bortezomib as frontline therapy, and 9 patients received bortezomib after 1 to 4 lines of chemotherapy, including autologous stem cell transplantation and thalidomide. RESULTS According to the International uniform response criteria of the International Myeloma Working Group, 5 partial responses (defined as a reduction in M-protein of >50%), 4 very good partial responses (defined as a reduction of >90% in M-protein), and 2 complete responses (defined as negative immunofixation) were achieved, for a response rate of 92%. Responses did not appear to be influenced by previous treatments or by other clinical or biologic parameters, including chromosome 13 deletion or the combination of bortezomib with other drugs. The median progression-free and overall survivals after bortezomib were 8 months and 12 months, respectively. At the time of last follow-up, 8 patients were alive 6 to 21 months after treatment with bortezomib, 4 of whom were in very good partial or complete responses. Grade 3/4 hematologic or neurologic toxicities (graded according to the Common Terminology Criteria for Adverse Events [CTCAE; version 3]) were reported to occur in 9 patients and 1 patient, respectively, whereas 6 patients experienced possible or documented infections. CONCLUSIONS Bortezomib appears to be an effective drug for PCL that could significantly improve the usually adverse clinical outcome of these patients.
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Affiliation(s)
- Pellegrino Musto
- Unit of Hematology and Stem Cell Transplantation, CROB-Reference Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy.
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Stewart AK, Bergsagel PL, Greipp PR, Dispenzieri A, Gertz MA, Hayman SR, Kumar S, Lacy MQ, Lust JA, Russell SJ, Witzig TE, Zeldenrust SR, Dingli D, Reeder CB, Roy V, Kyle RA, Rajkumar SV, Fonseca R. A practical guide to defining high-risk myeloma for clinical trials, patient counseling and choice of therapy. Leukemia 2007; 21:529-34. [PMID: 17230230 DOI: 10.1038/sj.leu.2404516] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinical outcomes for multiple myeloma (MM) are highly heterogeneous and it is now clear that pivotal genetic events are the primary harbingers of such variation. These findings have broad implications for counseling, choice of therapy and the design and interpretation of clinical investigation. Indeed, as in acute leukemias and non-hodgkins lymphoma, we believe it is no longer acceptable to consider MM a single disease entity. As such, the accurate diagnosis of MM subtypes and the adoption of common criteria for the identification and stratification of MM patients has become critical. Herein, we provide a consensus high-risk definition and offer practical guidelines for the adoption of routine diagnostic testing. Although acknowledging that more refined classifications will continue to be developed, we propose that the definition of high-risk disease (any of the t(4;14), t(14;16), t(14;20), deletion 17q13, aneuploidy or deletion chromosome 13 by metaphase cytogenetics, or plasma cell labeling index >3.0) be adopted. This classification will identify most of the 25% of MM patients for whom current therapies are inadequate and for whom investigational regimens should be vigorously pursued. Conversely, the 75% of patients remaining have more favorable outcomes using existing - albeit non-curative - therapeutic options.
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Affiliation(s)
- A K Stewart
- Department of Medicine, Division of Hematology-Oncology, Mayo Clinic College of Medicine, Scottsdale, AZ 85259, USA.
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