Abstract
The clinical features and response to therapy of 32 Chinese patients with localised plasmacytoma are presented, and a comparison between extramedullary plasmacytoma (EMP) and solitary plasmacytoma of bone (SPB) is made. Twenty-two patients had SPB and ten had EMP, accounting for 9% of all of our plasma cell neoplasms. Both groups had a male predominance with a median age of 54 years for SPB and 63 years for EMP. The common sites of SPB included vertebral bodies (15) and the skull (4). Most EMPs occurred in the oronasopharynx (6) and paranasal sinuses (2). An M-protein was detected in eight patients with SPB and in six with EMP. Seventeen patients with SPB and seven with EMP received radiation therapy, and all achieved initial local control. The pattern of failure in 22 patients with SPB manifested as local recurrence in two, multiple bone metastases without bone marrow plasmacytosis in two, multiple EMP progression in two, and development of multiple myeloma (MM) in one. There were two local recurrences, one further solitary bone involvement and one MM conversion in the EMP group. Local recurrence or dissemination was associated with the appearance of M-protein or an increase in the M-protein level in both groups. There was no significant difference in M-protein status or incidence and patterns of failure between the two groups. Patients with EMP had a more favourable overall survival than those with SPB (P = 0.03). The 5 year disease-free survival rate was 79% for EMP and 58% for SPB (P = 0.53). Patients aged less than 60 years had a better overall survival in the SPB group, but location of tumour, presence of M-protein, radiation dose and chemotherapy did not influence prognosis in either group. Our results indicate that adequate local therapy can result in long-term survival with a low frequency of MM progression for patients with localised plasmacytomas, and both EMP and SPB appear to be similar in terms of frequency and patterns of failure.
Highlights
Localised plasmacytomas are rare tumours, and account for 5-10% of all plasma cell neoplasms in Western countries (Corwin & Lindberg, 1979; Knowling et at., 1983; Mayr et al, 1990; Dimopoulos et al, 1992)
Considerable debate exists regarding the relationship of Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMP) to multiple myeloma (MM)
Most authors agree that EMP has a different natural history from both SPB and MM and believe that SPB is an early presentation of MM (Wiltshaw, 1976; Corwin & Lindberg, 1979; Knowling et al, 1983; Chak et al, 1987; Holland et al, 1992), whereas others consider that SPB is a clinical entity distinct from MM (Bataille & Sany, 1981; Delauche-Cavallier et al, 1988)
Summary
Between January 1978 and April 1993, 356 consecutive Chinese patients with newly diagnosed plasma cell malignan-. Correspondence: LY Shih, Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei, Taiwan, Republic of China Received 20 May 1994; revised 20 August 1994; accepted 29 August 1994 cies were evaluated at the division of Hematology-Oncology, Chang Gung Memorial Hospital, Taiwan Of these patients, 32 had solitary plasmacytomas which were defined as (1) having a radiologically solitary lytic bone lesion or soft-tissue mass which was histologically proven to be a plasmacytoma, (2) less than 5% plasma cells in the bone marrow at diagnosis and (3) no anaemia, hypercalcaemia or impairment of renal function. Patients with M-protein in the serum or urine at presentation were not excluded from the study if they met the above criteria
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