Managing plasma cell leukemia

Hematopoietic cell transplantation utilization and outcomes for primary plasma cell leukemia in the current era

The outcomes of patients with primary plasma cell leukemia (pPCL) after undergoing hematopoietic cell transplantation (HCT) in the novel agent era are unknown. We report outcomes of 348 patients with pPCL receiving autologous (auto-) HCT (n = 277) and allogeneic (allo-) HCT (n = 71) between 2008 and 2015. Median age was 60 years and 56 years for auto- and allo-HCT respectively. For auto-HCT, the 4-year outcomes were: non-relapse mortality (NRM) 7% (4-11%), relapse (REL) 76% (69-82%), progression-free survival (PFS) 17% (13-23%), and overall survival (OS) 28% (22-35%). Karnofsky performance status (KPS) > 90 and ≥very good partial response (VGPR) predicted superior OS in multi-variate analysis for auto-HCT. For allo-HCT, the 4-year outcomes were: NRM 12% (5-21%), REL 69% (56-81%), PFS 19% (10-31%), and OS 31% (19-44%). Compared with prior CIBMTR pPCL patients (1995-2006), inferior survival was noted in the current cohort (3-year OS, 39% vs. 38% in allo-HCT, and 62% vs. 35% in auto-HCT) respectively. However, we noted an increased HCT utilization, from 12% (7-21%) in 1995 to 46% (34-64%) in 2009 using SEER data (available till 2009). Despite modern induction translating to higher proportion receiving HCT, the outcomes remain poor in pPCL patients, mainly derived by high relapse rates post-HCT.

Hematopoietic cell transplantation for primary plasma cell leukemia: results from the Center for International Blood and Marrow Transplant Research

There is limited data on hematopoietic cell transplantation (HCT) in primary plasma cell leukemia (pPCL), an aggressive plasma cell disorder. We report outcomes of 147 patients with pPCL receiving autologous (n=97) or allogeneic (n=50) HCT within 18 months after diagnosis between 1995 and 2006. Median age was 56 years and 48 years for autologous HCT and allogeneic HCT respectively. Progression-free survival (PFS) at 3 years was 34% (95% CI, 23%-46%) in the autologous group and 20% (95% CI, 10%-34%) in the allogeneic group. Cumulative incidence of relapse at 3 years was 61% (95% CI, 48%-72%) in the autologous group and 38% (95% CI, 25%-53%) in the allogeneic group. Overall survival (OS) at 3 years was 64% (95% CI, 52%-75%) in the autologous group and 39% (95% CI, 26%-54%) in the allogeneic group. Non-relapse mortality (NRM) at 3 years was 5% (95% CI, 1-11%) in the autologous group and 41% (95% CI, 28%-56%) in the allogeneic group. The encouraging OS after autologous HCT, establishes the safety and feasibility of this consolidative treatment option after initial induction therapy for pPCL. Allogeneic HCT, although associated with a significantly lower relapse rate, carries a much higher risk of NRM and no overall survival benefit.

Primary plasma cell leukemia with light chain secretion and multiple chromosomal abnormalities: How successfully treated? - A case report with review of literature

Primary plasma cell leukemia is a rare form of plasma cell dyscrasia. We present a case which had leukocytosis with numerous circulating plasma cells in the peripheral blood. Flow cytometry revealed an unusual CD117 expression. Free light chain analysis in the serum showed a markedly elevated level of free lambda light chains. Radiography did not reveal any lytic lesions. Fluorescent in-situ hybridization analysis revealed deletion of 13q14.3 and t(4;14)/t(11;14), while the cytogenetic analysis was normal. The patient was given chemotherapy and was subjected to autologous stem cell transplant, after which she is in complete remission till date.

Effective PAD (bortezomib, doxorubicine, dexamethasone) treatment of a patient with plasma cell leukaemia developed after autologous stem cell transplantation

A plazmasejtes leukémia a myeloma multiplex ritka és agresszív megjelenési formája. Kezelése megoldatlan, és különösen a szekunder plazmasejtes leukémiák esetén várható gyors progresszió. A szekunder formában ugyanis többnyire intenzív kemoterápiában részesült myelomás betegekben terminálisan következik be a leukémiás transzformáció, míg a primer esetekben már a diagnózis idején kimutathatók a plazmasejtes leukémia tünetei. A szerzők nem szekretoros myeloma multiplex miatt perifériás autológ őssejt-transzplantáción átesett plazmasejtes leukémiás betegük kezelését ismertetik. A bortezomib (proteaszómagátló), a doxorubicin és a dexamethason kombinációja (PAD-protokoll) komplett remissziót és kilenc hónapos túlélést eredményezett. A többnyire betegismertetéseken alapuló irodalmi adatok szerint a PAD-protokoll, saját tapasztalatunkhoz hasonlóan, plazmasejtes leukémiában is hatékony és jól tolerálható. Autológ és/vagy allogén transzplantációval kombinálva a betegek túlélésének további javulása várható.

Response of primary plasma cell leukemia to the combination of bortezomib and dexamethasone: do specific cytogenetic and immunophenotypic characteristics influence treatment outcome?

Plasma cell leukemia (PCL) is a rare and aggressive form of plasma cell dyscrasias. Its special biological characteristics may play an important role in the poor outcome when treated with conventional therapy or even with stem cell transplantation. New treatment approaches based on the biology of this disease are mandatory. Here we present three cases of primary PCL with adverse cytogenetics (deletion 13q14 and translocation 4;14) and specific immunophenotypic features (CD27 antigen strong expression) in which excellent response and sustained remission was achieved with the combination of bortezomib and dexamethasone. The possible role of these biological characteristics is been analyzed.