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Mele G, Derudas D, Conticello C, Barilà G, Gentile M, Rocco S, Palmieri S, Palazzo G, Germano C, Reddiconto G, Sgherza N, De Novellis D, Galeone C, Castiglioni SA, Deiana L, Pascarella A, Martino EA, Foggetti I, Blasi I, Spina A, Di Renzo N, Maggi A, Tarantini G, Di Raimondo F, Specchia G, Musto P, Pastore D. Daratumumab-based regimens for patients with multiple myeloma plus extramedullary plasmacytomas or paraskeletal plasmacytomas: initial follow-up of an Italian multicenter observational clinical experience. Ann Hematol 2024:10.1007/s00277-024-05811-y. [PMID: 38805036 DOI: 10.1007/s00277-024-05811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Myeloma with extramedullary plasmacytomas not adjacent to bone (EMP) is associated with an extremely poor outcome compared with paraosseous plasmacytomas (PP) as current therapeutic approaches are unsatisfactory. The role of new molecules and in particular of monoclonal antibodies is under investigation. To determine whether daratumumab-based regimens are effective for myeloma with EMP, we report herein an initial multicenter observational analysis of 102 myeloma patients with EMP (n = 10) and PP (n = 25) at diagnosis and EMP (n = 28) and PP (n = 39) at relapse, treated with daratumumab-based regimens at 11 Haematological Centers in Italy.EMP and PP at diagnosis were associated with higher biochemical (90% vs. 96%, respectively) and instrumental ORR (86% vs. 83.3%, respectively), while at relapse, biochemical (74% vs. 73%) and instrumental (53% vs. 59%) ORR were lower. Median OS was inferior in EMP patients compared with patients with PP both at diagnosis (21.0 months vs. NR) (p = 0.005) and at relapse (32.0 vs. 40.0 months) (p = 0.428), although, during relapse, there was no statistically significant difference between the two groups. Surprisingly, at diagnosis, median TTP and median TTNT were not reached either in EMP patients or PP patients and during relapse there were no statistically significant differences in terms of median TTP (20 months for two groups), and median TTNT (24 months for PP patients vs. 22 months for EMP patients) between the two groups. Median TTR was 1 month in all populations.These promising results were documented even in the absence of local radiotherapy and in transplant-ineligible patients.
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Affiliation(s)
| | - Daniele Derudas
- Haematology, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Concetta Conticello
- Haematology, AOU Policlinico G. Rodolico-San Marco, Università degli Studi di Catania, Catania, Italy
| | - Gregorio Barilà
- Haematology, Ospedale San Bortolo, Vicenza, Italy
- Haematology, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | | | | | | | | | - Candida Germano
- Haematology, Ospedale Monsignor R. Dimiccoli, Barletta, BA, Italy
| | | | - Nicola Sgherza
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Danilo De Novellis
- Haematology, Ospedale Universitario San Giovanni di Dio e Ruggi D'Aragona, Università degli Studi di Salerno, Salerno, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Sara Agavni' Castiglioni
- Department of Statistical Sciences, Università degli Studi di Padova, National Cancer Institute of the National Institutes of Health (U24CA180996), Padova, Italy
| | - Luca Deiana
- Haematology, Ospedale Oncologico A. Businco, Cagliari, Italy
| | | | | | | | - Ilenia Blasi
- Haematology, Ospedale A. Perrino, Brindisi, Italy
| | | | | | | | | | - Francesco Di Raimondo
- Haematology, AOU Policlinico G. Rodolico-San Marco, Università degli Studi di Catania, Catania, Italy
| | - Giorgina Specchia
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pellegrino Musto
- Haematology, AOU Consorziale Policlinico, Università degli Studi di Bari "Aldo Moro", Bari, Italy
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Rezvani A, Shahriarirad R, Fallahi MJ, Zeighami A. Extramedullary relapse of Immunoglobulin A-kappa myeloma manifesting as plasmacytoma of the pleura without bone marrow involvement and following autologous bone marrow transplant: a case report. J Med Case Rep 2023; 17:42. [PMID: 36759913 PMCID: PMC9912644 DOI: 10.1186/s13256-023-03765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Recurrence of multiple myeloma is among the most challenging issues for patients and treating physicians reported after autologous stem cell transplantation. However, extramedullary involvement after chemotherapy and transplantation has been rarely reported, especially as pleural manifestations. Protein electrophoresis indicated immunoglobulin A monoclonal kappa plasma cell neoplasm in our case. CASE PRESENTATION A 48-year-old middle-eastern man was referred to our clinic with cough, dyspnea, fever, and left side pleural effusion. A year after chemotherapy and autologous bone marrow transplantation, the patient presented with features in favor of pleural relapse, without bone marrow involvement. Protein electrophoresis demonstrated immunoglobulin A monoclonal kappa plasma cell neoplasm in our case. The patient was effectively treated with dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide, and etoposide with no notable adverse effects. CONCLUSION Physicians should be aware of various presentations of multiple myeloma relapse, especially in autologous stem cell transplantation patients. Atypical and unique presentations such as the pleural involvement warrant further reporting of evidence to provide early management and treatment options.
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Affiliation(s)
- Alireza Rezvani
- grid.412571.40000 0000 8819 4698Bone Marrow Transplantation Center, Nemazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran ,grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311 Iran
| | - Reza Shahriarirad
- grid.412571.40000 0000 8819 4698Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311 Iran ,grid.412571.40000 0000 8819 4698Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- grid.412571.40000 0000 8819 4698Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Zeighami
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, 71936-13311, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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Sokhi DS, Mithi CW, Ebrahim FA, Salyani A, Waa S, Riyat MS. Collet-Sicard syndrome due to concurrent extramedullary intracranial plasmacytoma and jugular venous sinus thrombosis in multiple myeloma. Clin Case Rep 2021; 9:e04457. [PMID: 34336210 PMCID: PMC8319375 DOI: 10.1002/ccr3.4457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022] Open
Abstract
In a patient with Collet-Sicard syndrome and multiple myeloma, both extramedullary plasmacytomas and internal jugular vein-sigmoid sinus thrombosis should be considered as they can coexist.
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Affiliation(s)
- Dilraj Singh Sokhi
- Department of Medicine, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
| | - Caroline Wangui Mithi
- Department of Medicine, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
| | - Farah Alnoor Ebrahim
- Department of Medicine, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
| | - Adil Salyani
- Department of Medicine, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
| | - Sheila Waa
- Department of Radiology, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
| | - Malkit Singh Riyat
- Department of Oncology and Haematology, Faculty of Health SciencesThe Aga Khan University HospitalAga Khan University Medical College of East AfricaNairobiKenya
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Carfilzomib Based Treatment Strategies in the Management of Relapsed/Refractory Multiple Myeloma with Extramedullary Disease. Cancers (Basel) 2020; 12:cancers12041035. [PMID: 32340174 PMCID: PMC7225914 DOI: 10.3390/cancers12041035] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Published experience with carfilzomib in patients with relapsed/refractory multiple myeloma (RRMM) and extramedullary disease (EMD) is still limited. The current study aimed to assess the efficacy and safety of carfilzomib containing therapy regimens in EMD. We retrospectively analyzed 45 patients with extramedullary RRMM treated with carfilzomib from June 2013 to September 2019. The median age at the start of carfilzomib was 64 (range 40-80) years. Twenty (44%) and 25 (56%) patients had paraosseous manifestation and EMD without adjacency to bone, respectively. The serological overall response rate (ORR) was 59%. Extramedullary response was evaluable in 33 patients, nine (27%) of them achieved partial remission (PR) (ORR = 27%). In 15 (33%) patients, we observed no extramedullary response despite serological response. The median progression-free survival (PFS) and overall survival (OS) were five (95% CI, 3.5-6.5) and ten (95% CI, 7.5-12.5) months, respectively. EMD without adjacency to bone was associated with a significantly inferior PFS (p = 0.004) and OS (p = 0.04) compared to paraosseous lesions. Carfilzomib based treatment strategies showed some efficacy in heavily pretreated patients with extramedullary RRMM but could not overcome the negative prognostic value of EMD. Due to the discrepancy between serological and extramedullary response, evaluation of extramedullary response using imaging is mandatory in these patients.
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