Multiple Extramedullary Plasmacytoma in A Setting of Complete Bone Marrow Remission: Food for Thought
AbstractExtramedullary plasmacytoma as a mode of relapse in multiple myeloma (MM) is unusual. Current recommendations do not incorporate the routine use of 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) imaging prior to haematopoietic stem cell transplant (HSCT) in MM. We report a case of relapsed MM with complete remission as per IMWG criteria. In the interim period, before the HSCT, the patient had localizing neurological signs and symptoms attributed to multiple extramedullary plasmacytomas. The uniqueness of this case is that this patient after complete marrow remission with no obvious external masses had unexpected, symptomatic multiple extramedullary plasmacytomas. This case illustrates the need for integration of FDG PET/CT imaging into routine pre-HSCT investigations in relapsed MM to prevent missing any asymptomatic extramedullary plasmacytomas.
Kilciksiz S, Karakoyun-Celik O, Agaoglu FY, et al. A review for solitary plasmacytoma of bone and extramedullary plasmacytoma. ScientificWorldJournal. 2012; 2012: 895765
Galieni P, Cavo M, Pulsoni A, et al. Clinical outcome of extramedullary plasmacytoma. Haematologica. 2000; 85(1):47-51.
Sabir H, Kumnhare S, Parate A, et al. A 65-year old female with synchronous HIV and Extramedullary Plasmacytoma of Maxillary Sinus. Gulf J Oncolog. 2015; 1(19):18-23.
Zhang I, Zhang X, Zhang R, et al. 18F-FDG PET/CT Metabolic activity in a patient with solitary extramedullary plasmacytoma of the lung. Clin Nucl Med. 2016; 41(3):232-4.
Blade J, Fernandez de Larrea C, Rosinol L, et al. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread and treatment approach. J Clin Oncol. 2011; 29(28):3805-12.
Güler N. Extramedullary plasmacytoma: tumour occurrence and therapeutic concepts. Cancer. 2000; 88(1):240-2.
Liebross RH, Ha CS, Cox JD, et al. Clinical course of solitary extramedullary plasmacytoma. Radiother Oncol. 1999; 52(3):245-9.
Puliga G, Olla L, Bellisano G, et al. Solitary extramedullary plasmacytoma of the thyroid gland associated with multinodular goiter: case report and review of literature. Pathologica. 2011; 103(3):61-3.
Aguado B, Iñigo B, Sastre JL, et al. Extramedullary plasmacytomas in the context of multiple myeloma. Adv Ther. 28 Suppl 7:7-13
Lu YY, Chen JH, Lin WY, et al. FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple myeloma: a systematic review and meta-analysis. Clin Nucl Med. 2012; 37(9):833-7.
Caldarella C, Annunziata S, Pagano L, et al. Improved detection of minimal residual disease by 11C-methionine PET/CT in a young patient with unusual extramedullary presentation of recurrent multiple myeloma. Clin Nucl Med. 2017; 42(2): e130-e134.
Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumours of bone. J Clin Oncol. 1983; 1(4):255-62.
Krivanova A, Hájek R, Krejcí M, et al. Second autologous transplantation for multiple myeloma patients relapsing after the first autograft- a pilot study for the evaluation of experimental maintenance therapies. Report of the prospective non-randomized pilot study of the Czech Myeloma Group. Onkologie. 2004; 27(3):275-9.
Barlogie B, Anaissie E, van Rhee F, et al. Reiterative survival analyses of total therapy 2 for multiple myeloma elucidate follow-up time dependency of prognostic variables and treatment arms. J Clin Oncol. 2010; 28(18):3023-7.
Sung PS, Song JH, Park CW. A case of multiple pulmonary plasmacytomas after complete remission of multiple myeloma. Tuberc Respir Dis. 2010; 69(2):129-133.
Rau T, Kamaya A. Relapsed extramedullary multiple myeloma presenting as bilateral solid perirenal masses. Radiol Case Rep. 2015; 2(4):93.
Pour L, Sevcikova S, Greslikova H, et al. Soft-tissue extramedullary multiple myeloma prognosis is significantly worse in comparison to bone-related extramedullary relapse. Haematologica. 2014; 99(2):360-4.
Bredella MA, Steinbach L, Caputo G, et al. Value of FDG PET in the assessment of patients with multiple myeloma. AJR Am J Roentgenol. 2005; 184(4):1199-204. 19. Fakhri AA, Rodrigue PD, Fakhri AF. Extramedullary plasmacytoma of the gallbladder detected on fluorine 18-fluorodeoxyglucose positron emission tomography / computed tomography. J Clin Imaging Sci. 2016; 6: 40.
de Waal EG, Glaudemans AW, Schröder CP , et al. Nuclear medicine imaging of multiple myeloma, particularly in the relapsed setting. Eur J Nucl Med Mol Imaging. 2017; 44 (2):332-341.
Yang G, Geng C, Li Y, et al. Multiple myeloma with extramedullary plasmacytoma invading the skin and eyeballs following autologous stem cell transplantation: A case report. Exp Ther Med. 2013; 6(4):883-886.
Fernándezde Larrea C, Jiménez R, Rosiñol L, et al. Pattern of relapse and progression after autologous SCT as upfront treatment for multiple myeloma. Bone Marrow Transplant. 2014; 49(2):223-7.
Gonzalez de la Calle V, Alonso S, Del Carmen S, et al. Bilateral synchronous testicular plasmacytoma as extramedullary relapse in high-risk multiple myeloma patient. Ann Hematol Oncol.2015; 2(4):1032.