Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

The predictive value of serum myeloma protein in solitary plasmacytoma

  • Chang, Won Ick (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Koh, Hyeon Kang (Department of Radiation Oncology, Konkuk University Medical Center) ;
  • Yoon, Sung-Soo (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Han-Soo (Department of Orthopedic Surgery, Seoul National University College of Medicine) ;
  • Eom, Keun-Yong (Department of Radiation Oncology, Seoul National University Bundang Hospital) ;
  • Kim, Il Han (Department of Radiation Oncology, Seoul National University College of Medicine)
  • Received : 2019.10.28
  • Accepted : 2020.05.26
  • Published : 2020.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To identify the clinical usefulness of serum M protein and to establish a rationale for regular follow-up with serum protein electrophoresis in solitary plasmacytoma. Materials and Methods: Sixty-nine patients with solitary plasmacytoma and solitary plasmacytoma with minimal marrow involvement according to the International Myeloma Working Group criteria were retrospectively reviewed. Results: At a median follow-up of 6.2 years, 5-year local control (LC), 5-year multiple myeloma-free survival (MMFS), 5-year failure-free survival (FFS), and 5-year overall survival (OS) were 82.6%, 44.1%, 41.8%, and 85.1%, respectively. Among the patients whose initial serum M protein was present or not evaluated, 37.3% of patients showed disappearance of serum M protein after various treatment. MMFS of these patients were comparable to non-secretory plasmacytoma with undetectable levels of M protein, and significantly better than patients with persistent M protein. Increase of serum M protein ≥0.1 g/dL was most predictive of treatment failure with area under the curve of 0.731. Conclusion: Patients who eventually showed persistence of serum M protein after treatment showed worse MMFS and FFS compared to those whose serum M protein disappeared or who had initially non-secretory disease. The increase of serum M protein level ≥0.1 g/dL from current nadir was predictive of treatment failure. Therefore, regular follow-up with serum M protein is highly recommended especially unless the patient had initially non-secretory disease.

Keywords

References

  1. Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone. J Clin Oncol 1983;1:255-62. https://doi.org/10.1200/JCO.1983.1.4.255
  2. Thumallapally N, Meshref A, Mousa M, Terjanian T. Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA. BMC Cancer 2017;17:13. https://doi.org/10.1186/s12885-016-3015-5
  3. Ozsahin M, Tsang RW, Poortmans P, et al. Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients. Int J Radiat Oncol Biol Phys 2006;64:210-7. https://doi.org/10.1016/j.ijrobp.2005.06.039
  4. Suh YG, Suh CO, Kim JS, Kim SJ, Pyun HO, Cho J. Radiotherapy for solitary plasmacytoma of bone and soft tissue: outcomes and prognostic factors. Ann Hematol 2012;91:1785-93. https://doi.org/10.1007/s00277-012-1510-6
  5. Reed V, Shah J, Medeiros LJ, et al. Solitary plasmacytomas: outcome and prognostic factors after definitive radiation therapy. Cancer 2011;117:4468-74. https://doi.org/10.1002/cncr.26031
  6. Sasaki R, Yasuda K, Abe E, et al. Multi-institutional analysis of solitary extramedullary plasmacytoma of the head and neck treated with curative radiotherapy. Int J Radiat Oncol Biol Phys 2012;82:626-34. https://doi.org/10.1016/j.ijrobp.2010.11.037
  7. Mendenhall CM, Thar TL, Million RR. Solitary plasmacytoma of bone and soft tissue. Int J Radiat Oncol Biol Phys 1980;6:1497-501. https://doi.org/10.1016/0360-3016(80)90006-1
  8. Finsinger P, Grammatico S, Chisini M, Piciocchi A, Foa R, Petrucci MT. Clinical features and prognostic factors in solitary plasmacytoma. Br J Haematol 2016;172:554-60. https://doi.org/10.1111/bjh.13870
  9. Dagan R, Morris CG, Kirwan J, Mendenhall WM. Solitary plasmacytoma. Am J Clin Oncol 2009;32:612-7. https://doi.org/10.1097/COC.0b013e31819cca18
  10. Kumar S, Paiva B, Anderson KC, et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2016;17:e328-e346.
  11. Kyle RA, Gertz MA, Witzig TE, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003;78:21-33. https://doi.org/10.4065/78.1.21
  12. Dingli D, Kyle RA, Rajkumar SV, et al. Immunoglobulin free light chains and solitary plasmacytoma of bone. Blood 2006;108:1979-83.
  13. Liebross RH, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Solitary bone plasmacytoma: outcome and prognostic factors following radiotherapy. Int J Radiat Oncol Biol Phys 1998;41:1063-7. https://doi.org/10.1016/S0360-3016(98)00186-2
  14. Wilder RB, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Persistence of myeloma protein for more than one year after radiotherapy is an adverse prognostic factor in solitary plasmacytoma of bone. Cancer 2002;94:1532-7. https://doi.org/10.1002/cncr.10366
  15. Caers J, Paiva B, Zamagni E, et al. Diagnosis, treatment, and response assessment in solitary plasmacytoma: updated recommendations from a European Expert Panel. J Hematol Oncol 2018;11:10. https://doi.org/10.1186/s13045-017-0549-1
  16. Dimopoulos M, Spencer A, Attal M, et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med 2007;357:2123-32. https://doi.org/10.1056/NEJMoa070594
  17. Weber DM, Chen C, Niesvizky R, et al. Lenalidomide plus dexamethasone for relapsed multiple myeloma in North America. N Engl J Med 2007;357:2133-42. https://doi.org/10.1056/NEJMoa070596
  18. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538-48.
  19. Tsang RW, Gospodarowicz MK, Pintilie M, et al. Solitary plasmacytoma treated with radiotherapy: impact of tumor size on outcome. Int J Radiat Oncol Biol Phys 2001;50:113-20. https://doi.org/10.1016/S0360-3016(00)01572-8
  20. Knobel D, Zouhair A, Tsang RW, et al. Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study. BMC Cancer 2006;6:118. https://doi.org/10.1186/1471-2407-6-118
  21. Goyal G, Bartley AC, Funni S, et al. Treatment approaches and outcomes in plasmacytomas: analysis using a national dataset. Leukemia 2018;32:1414-20. https://doi.org/10.1038/s41375-018-0099-8
  22. Warsame R, Gertz MA, Lacy MQ, et al. Trends and outcomes of modern staging of solitary plasmacytoma of bone. Am J Hematol 2012;87:647-51. https://doi.org/10.1002/ajh.23201
  23. Papadaki HA, Stefanaki K, Kanavaros P, et al. Epstein-Barr virus-associated high-grade anaplastic plasmacytoma in a renal transplant patient. Leuk Lymphoma 2000;36:411-5. https://doi.org/10.3109/10428190009148863
  24. Lakshminarayanan R, Li Y, Janatpour K, Beckett L, Jialal I. Detection by immunofixation of M proteins in hypogammaglobulinemic patients with normal serum protein electrophoresis results. Am J Clin Pathol 2007;127:746-51. https://doi.org/10.1309/QJ3PY18PMMJ8AYEH
  25. Soutar R, Lucraft H, Jackson G, et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol 2004;124:717-26. https://doi.org/10.1111/j.1365-2141.2004.04834.x
  26. Tsang RW, Campbell BA, Goda JS, et al. Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018;101:794-808. https://doi.org/10.1016/j.ijrobp.2018.05.009
  27. Tournier-Rangeard L, Lapeyre M, Graff-Caillaud P, et al. Radiotherapy for solitary extramedullary plasmacytoma in the head-and-neck region: a dose greater than 45 Gy to the target volume improves the local control. Int J Radiat Oncol Biol Phys 2006;64:1013-7. https://doi.org/10.1016/j.ijrobp.2005.09.019