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Guan J, Ma J, Chen B. Clinical and cytogenetic characteristics of primary and secondary plasma cell leukemia under the new IMWG definition criteria: a retrospective study. Hematology 2023; 28:2254556. [PMID: 37732631 DOI: 10.1080/16078454.2023.2254556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, exhibiting a more unfavorable prognosis than multiple myeloma. PCL is classified into pPCL and sPCL. Recently, the IMWG has recommended new PCL definition criteria, which require the presence of ≥5% circulating plasma cells in peripheral blood smears. Due to its low incidence, research on pPCL and sPCL is limited. METHODS We conducted a retrospective study and analyzed clinical and cytogenetic data of pPCL and sPCL patients. Overall survival (OS) and progression-free survival (PFS) were assessed by the Kaplan-Meier method, and survival distributions were compared using the log-rank test. RESULTS This is a small cohort comprising 23 pPCL and 9 sPCL patients. Notably, sPCL patients showed a higher incidence of extramedullary infiltration and a higher percentage of bone marrow plasma cells (p = 0.015 and 0.025, respectively). Although no significant difference was found between the two groups in OS and PFS, a trend emerged suggesting a superior survival outcome for pPCL patients, with a higher cumulative 1-year PFS rate (38.3% vs. 13.3%) and a lower early mortality rate (mortality rate at 3 months: 15% vs. 33%). We also suggested that pPCL patients carrying t(11;14) may have a longer median survival time than individuals with other cytogenetic abnormalities, but this was not confirmed due to the small sample size. CONCLUSION Our study revealed clinical and cytogenetic features of pPCL and sPCL patients according to the new diagnostic criteria. The findings suggested a generally better prognosis for pPCL than sPCL and the likelihood of t(11;14) translocation acting as a favorable prognostic factor in pPCL. It is important to note that our study had a limited sample size, which may lead to bias. We hope well-designed studies can be conducted to provide more results.
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Affiliation(s)
- Jiaheng Guan
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Jinlong Ma
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China
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2
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Fu W, Huang A, Luo Y, Liu M, Tang G, Yang J, Ni X. Sequential autologous and allogeneic stem cell transplantation for treatment of primary plasma cell leukemia: A case report. Mol Clin Oncol 2023; 19:75. [PMID: 37614372 PMCID: PMC10442742 DOI: 10.3892/mco.2023.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive form of plasma cell disorder, which accounts for ~70% of all PCL. Survival of pPCL remains poor, and is related with early mortality. There is no standard therapy for patients with pPCL. In the present study, a 26-year-old man who was diagnosed with pPCL was reported. The patient achieved stringent complete remission to the successful treatment of intensive chemotherapy combined with sequential autologous and allogeneic stem cell transplantation (SCT) followed by maintenance therapy with oral administration of ixazomib, thalidomide and dexamethasone (IRD regimen). Development of complex treatment algorithms that combine novel agents, SCT and post-transplantation remission strategies may translate into survival in patients with pPCL.
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Affiliation(s)
- Weijia Fu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Aijie Huang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Yanrong Luo
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Miaomiao Liu
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Gusheng Tang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Jianmin Yang
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
| | - Xiong Ni
- Department of Hematology, Institute of Hematology, Changhai Hospital, Shanghai 200433, P.R. China
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3
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Validation of the revised diagnostic criteria for primary plasma cell leukemia by the Korean Multiple Myeloma Working Party. Blood Cancer J 2022; 12:157. [PMID: 36404323 PMCID: PMC9676183 DOI: 10.1038/s41408-022-00755-w] [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: 08/18/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
Abstract
The International Myeloma Working Group has recently revised the diagnostic criteria for primary plasma cell leukemia (PCL) to circulating plasma cells (CPCs) ≥ 5% in a peripheral blood smear. The present study validated new criteria in patients with multiple myeloma or PCL diagnosed using the previous diagnostic criteria, who were administered immunomodulatory drugs or proteasome inhibitors as induction therapy. We analyzed the medical records of 1357 patients from eight hospitals in South Korea. The median age of the all patients was 64 years, and 187 (13.8%) had CPCs at diagnosis. Only 79 (5.8%) of the patients had ≥ 5% CPCs. The median overall survival (OS) of patients with CPCs ≥ 5% and ≥ 20% was similar, but had significantly inferior median progression-free survival (PFS) and median OS than those with CPCs < 5% (13.1 vs. 21.5 months, P < 0.001, and 21.5 vs. 60.9 months, P < 0.001, respectively). Primary PCL diagnosed using the revised criteria presented with higher total calcium levels and serum creatinine levels, lower platelet counts and frequent organomegaly and plasmacytoma at diagnosis. Univariate and multivariate analyses demonstrated that the presence of plasmacytoma and elevated serum β2-microglobulin were significantly associated with OS in primary PCL. In conclusion, the revised criterion of CPCs ≥ 5% in a peripheral blood smear is appropriate for PCL diagnosis.
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[Update on biology of primary plasma cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:603-607. [PMID: 36709141 PMCID: PMC9395563 DOI: 10.3760/cma.j.issn.0253-2727.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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5
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Jung SH, Lee JJ. Update on primary plasma cell leukemia. Blood Res 2022; 57:62-66. [PMID: 35483928 PMCID: PMC9057670 DOI: 10.5045/br.2022.2022033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 01/01/2023] Open
Abstract
Plasma cell leukemia (PCL) is a rare and highly aggressive plasma cell neoplasm developing in 0.5?4% of patients with multiple myeloma (MM). The diagnostic criteria were recently revised from 20% to ≥5% of circulating plasma cells in peripheral blood smears. PCL is classified as primary or secondary; primary PCL is when it presents in patients with no MM. Primary PCL shows clinical and laboratory features at presentation that differ from MM and exhibits a dismal prognosis even with the use of effective agents against MM. Therefore, intensive chemotherapy should be initiated immediately after diagnosis, and autologous stem cell transplantation is recommended for transplant-eligible patients. Maintenance therapy after transplantation may reduce the rate of early relapses. We reviewed the definitions of PCL, revised diagnostic criteria, clinical features, and appropriate initial treatments for primary PCL.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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6
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Rojas EA, Gutiérrez NC. Genomics of Plasma Cell Leukemia. Cancers (Basel) 2022; 14:cancers14061594. [PMID: 35326746 PMCID: PMC8946729 DOI: 10.3390/cancers14061594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Plasma cell leukemia (PCL) is a very aggressive plasma cell disorder with a dismal prognosis, despite the therapeutic progress made in the last few years. The implementation of genomic high-throughput technologies in the clinical setting has revealed new insights into the genomic landscape of PCL, some of which may have an impact on the development of novel therapeutic approaches. The purpose of this review is to provide a comprehensive overview and update of the genomic studies carried out in PCL. Abstract Plasma cell leukemia (PCL) is a rare and highly aggressive plasma cell dyscrasia characterized by the presence of clonal circulating plasma cells in peripheral blood. PCL accounts for approximately 2–4% of all multiple myeloma (MM) cases. PCL can be classified in primary PCL (pPCL) when it appears de novo and in secondary PCL (sPCL) when it arises from a pre-existing relapsed/refractory MM. Despite the improvement in treatment modalities, the prognosis remains very poor. There is growing evidence that pPCL is a different clinicopathological entity as compared to MM, although the mechanisms underlying its pathogenesis are not fully elucidated. The development of new high-throughput technologies, such as microarrays and new generation sequencing (NGS), has contributed to a better understanding of the peculiar biological and clinical features of this disease. Relevant information is now available on cytogenetic alterations, genetic variants, transcriptome, methylation patterns, and non-coding RNA profiles. Additionally, attempts have been made to integrate genomic alterations with gene expression data. However, given the low frequency of PCL, most of the genetic information comes from retrospective studies with a small number of patients, sometimes leading to inconsistent results.
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Affiliation(s)
- Elizabeta A. Rojas
- Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Cancer Research Center-Institute of Cancer Molecular and Cellular Biology (CIC-IBMCC) (USAL-CSIC), 37007 Salamanca, Spain
| | - Norma C. Gutiérrez
- Hematology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Cancer Research Center-Institute of Cancer Molecular and Cellular Biology (CIC-IBMCC) (USAL-CSIC), 37007 Salamanca, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), CB16/12/00233, 28029 Madrid, Spain
- Grupo Español de Mieloma (GEM), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-923-291-200 (ext. 56617)
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7
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Papadhimitriou SI, Terpos E, Liapis K, Pavlidis D, Marinakis T, Kastritis E, Dimopoulos MA, Tsitsilonis OE, Kostopoulos IV. The Cytogenetic Profile of Primary and Secondary Plasma Cell Leukemia: Etiopathogenetic Perspectives, Prognostic Impact and Clinical Relevance to Newly Diagnosed Multiple Myeloma with Differential Circulating Clonal Plasma Cells. Biomedicines 2022; 10:biomedicines10020209. [PMID: 35203419 PMCID: PMC8869452 DOI: 10.3390/biomedicines10020209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/21/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell dyscrasia that may appear as de-novo leukemia (pPCL) or on the basis of a pre-existing multiple myeloma (MM), called secondary plasma cell leukemia (sPCL). In this prospective study, we have applied a broad panel of FISH probes in 965 newly diagnosed MM (NDMM) and 44 PCL cases of both types to reveal the particular cytogenetic differences among the three plasma cell dyscrasias. In order to evaluate the frequency and patterns of clonal evolution, the same FISH panel was applied both at diagnosis and at the time of first relapse for 81 relapsed MM patients and both at MM diagnosis and during sPCL transformation for the 19 sPCL cases described here. pPCL was characterized by frequent MYC translocations and t(11;14) with a 11q13 breakpoint centered on the MYEOV gene, not commonly seen in MM. sPCL had a higher number of FISH abnormalities and was strongly associated with the presence of del(17p13), either acquired at the initial MM stage or as a newly acquired lesion upon leukemogenesis in the context of the apparent clonal evolution observed in sPCL. In clinical terms, sPCL showed a shorter overall survival than pPCL with either standard or high-risk (t(4;14) and/or t(14;16) and/or del(17p13) and/or ≥3 concomitant aberrations) abnormalities (median 5 months vs. 21 and 11 months respectively, p < 0.001), suggesting a prognostic stratification based on cytogenetic background. These observations proved relevant in the NDMM setting, where higher levels of circulating plasma cells (CPCs) were strongly associated with high-risk cytogenetics (median frequency of CPCs: 0.11% of peripheral blood nucleated cells for high-risk vs. 0.007% for standard-risk NDMM, p < 0.0001). Most importantly, the combined evaluation of CPCs (higher or lower than a cut-off of 0.03%), together with patients’ cytogenetic status, could be used for an improved prognostic stratification of NDMM patients.
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Affiliation(s)
- Stefanos I. Papadhimitriou
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Konstantinos Liapis
- Department of Haematology, University Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece;
| | - Dimitrios Pavlidis
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
| | - Theodoros Marinakis
- Department of Clinical Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece;
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.T.); (E.K.); (M.-A.D.)
| | - Ourania E. Tsitsilonis
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
| | - Ioannis V. Kostopoulos
- Department of Laboratory Hematology, Athens Regional General Hospital “Georgios Gennimatas”, 11527 Athens, Greece; (S.I.P.); (D.P.)
- Department of Biology, School of Sciences, National and Kapodistrian University of Athens, Panepistimiopolis, Ilissia, 15784 Athens, Greece;
- Correspondence: or ; Tel.: +30-210-727-4929; Fax: +30-210-727-4635
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8
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Youssefi H, Ahnach M, Bendari M, Al Bouzidi A. Primary Plasma Cell Leukemia Revealed by a Mandibular Lesion: A Case Report. Cureus 2021; 13:e20148. [PMID: 35003980 PMCID: PMC8723764 DOI: 10.7759/cureus.20148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 11/05/2022] Open
Abstract
Primary plasma cell leukemia (PCL) is a rare and aggressive hematological malignancy exhibiting a circulating plasma cell count exceeding 20% of peripheral blood leukocytes or an absolute plasma cell count >2000/mm3. We report a case of a 37-year-old woman presented to the Department of Hematology with a two-month history of growth inside the oral cavity in the upper jaw and weakness. The physical examination revealed a voluminous mass involving the left side of the maxillary gingiva. The maxillofacial computerized tomography (CT) scan confirmed the presence of a solid tissue mass at the left upper maxilla. A biopsy sample obtained from the lesion showed a plasma cell infiltration. The laboratory findings revealed anemia, renal impairment with high levels of creatinine and calcium. Serum protein electrophoresis found a monoclonal peak at IgG lambda, a high level of lambda free light. The diagnosis was subsequently confirmed by a peripheral-blood smear revealed 25% of plasma cells and bone marrow aspiration with 50% of plasma cell infiltration. Primary plasma-cell leukemia (pPCL) was confirmed. The patient received VTD chemotherapy (bortezomib, thalidomide, and dexamethasone) followed by autologous stem cell transplant (ASCT), which resulted in complete remission. At the six-month follow-up, the patient relapsed with extramedullary multiple lesions under ineffective rescue therapy. Response to frontline treatments may be significant initially but short-lived with a dismal median overall survival below one year. This case report aims to highlight the need for awareness among clinicians of the relevance of examining other associated clinical features of pPCL, given its aggressive course and rapid progress without the therapy.
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Ahaneku H, Gupta R, Anusim N, Umeh CA, Anderson J, Jaiyesimi I. Leucocytoclastic Vasculitis, Cryoglobulinemia, or Plasma Cell Leukemia: A Diagnostic Conundrum. Cureus 2021; 13:e16832. [PMID: 34513422 PMCID: PMC8409693 DOI: 10.7759/cureus.16832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/06/2022] Open
Abstract
Plasma cell leukemia is rare and could be life-threatening. Even rarer and equally life-threatening is cryoglobulinemia. Both of them occurring together paints a grim clinical picture. We present the case of a 63-year-old male with plasma cell leukemia complicated by cryoglobulinemia with skin lesions. The report briefly reviews the clinical and diagnostic characteristics of plasma cell leukemia and well as available treatment options. It also highlights the need to consider non-chemotherapy-based regimens and clinical trials in the care of plasma cell leukemia patients.
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Affiliation(s)
| | - Ruby Gupta
- Hematology and Oncology, Beaumont Health, Royal Oak, USA
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10
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Gowin K, Skerget S, Keats JJ, Mikhael J, Cowan AJ. Plasma cell leukemia: A review of the molecular classification, diagnosis, and evidenced-based treatment. Leuk Res 2021; 111:106687. [PMID: 34425325 DOI: 10.1016/j.leukres.2021.106687] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/22/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
Plasma cell leukemia is a rare and aggressive plasma cell dyscrasia associated with dismal outcomes. It may arise de novo, primary plasma cell leukemia, or evolve from an antecedent diagnosis of multiple myeloma, secondary plasma cell leukemia. Despite highly effective therapeutics, survival for plasma cell leukemia patients remains poor. Molecular knowledge of plasma cell leukemia has recently expanded with use of gene expression profiling and whole exome sequencing, lending new insights into prognosis and therapeutic development. In this review, we describe the molecular knowledge, clinical characteristics, evidenced-based therapeutic approaches and treatment outcomes of plasma cell leukemia.
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Affiliation(s)
- Krisstina Gowin
- University of Arizona, Department of Bone Marrow Transplant and Cellular Therapy, Tucson, AZ, United States.
| | - Sheri Skerget
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Jonathan J Keats
- Translational Genomics Research Institute (TGen), Integrated Cancer Genomics Division, Phoenix, AZ, United States
| | - Joseph Mikhael
- Translational Genomics Research Institute (TGen), Applied Cancer Research and Drug Discovery Division, Phoenix, AZ, United States
| | - Andrew J Cowan
- University of Washington, Department of Hematology Oncology, Seattle, WA, United States
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11
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Ong'ondi M, Kagotho E. Plasma Cell Leukemia: A Review of 3 Cases Managed in Kenya. Case Rep Hematol 2021; 2021:4843818. [PMID: 34395001 PMCID: PMC8363435 DOI: 10.1155/2021/4843818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/17/2021] [Indexed: 12/03/2022] Open
Abstract
Plasma Cell Leukemia (PCL) is a rare and aggressive form of plasma cell dyscrasia that can arise either de novo (primary plasma cell leukemia) or evolve from previously diagnosed and treated multiple myeloma (secondary PCL). We highlight three clinical cases with very different presentations as a reminder of this diagnosis. The cases also highlight the diversity and variability that cover a patient's journey that is highly dependent on accessibility based on financial capability and social support. The clinical presentation is more aggressive due to the higher tumour burden and more proliferative tumor cells with cytopenias being profound and more organomegaly. The diagnosis is made based on at least 20% of total white blood cells being circulating plasma cells with a peripheral blood absolute plasma cell count of at least 2 × 109/l. Treatment with novel agents followed by autologous stem cell transplant in those who are transplant eligible leads to better outcomes.
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Affiliation(s)
- Matilda Ong'ondi
- Department of Internal Medicine; Hemato-oncology Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Elizabeth Kagotho
- Department of Pathology and Laboratory Medicine, Aga Khan University hospital, Nairobi, Kenya
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12
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Allogeneic Stem Cell Transplantation in Patients with High-Risk Multiple Myeloma: Utopia or Continuous Challenge in Aiming for Cure? Curr Treat Options Oncol 2021; 22:65. [PMID: 34110512 DOI: 10.1007/s11864-021-00864-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Nowadays, several novel agents have been introduced in the treatment of multiple myeloma, not only resulting in high response rates and prolonged survival but also offering good quality of life. However, the potential of cure, especially for patients with advanced or unfavorable disease features, remains elusive. Allogeneic hematopoietic stem cell transplantation, based mainly on the graft vs. myeloma effect, can offer prolonged disease control and probability of cure but unfortunately at the cost of considerable transplant-related toxicity rates. Therefore, the role of allogeneic hematopoietic stem cell transplantation in the treatment of multiple myeloma has been called into question. Recently, several studies, particularly those with long-term follow-up, demonstrated a trend of survival superiority for allografted patients with high-risk disease. These data fuel again the interest in allogeneic stem cell transplantation for selected patients with high-risk multiple myeloma, especially if the high remission rates which can be achieved with the currently used treatment protocols could be long-life sustained through the additional exploitation of the long-lasting anti-multiple myeloma effect, originating from the allograft.
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13
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Visram A, Suska A, Jurczyszyn A, Gonsalves WI. Practical management and assessment of primary plasma cell leukemia in the novel agent era. Cancer Treat Res Commun 2021; 28:100414. [PMID: 34174530 DOI: 10.1016/j.ctarc.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Visram
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - A Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - A Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - W I Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States.
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14
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Caro J, Al Hadidi S, Usmani S, Yee AJ, Raje N, Davies FE. How to Treat High-Risk Myeloma at Diagnosis and Relapse. Am Soc Clin Oncol Educ Book 2021; 41:291-309. [PMID: 34010042 DOI: 10.1200/edbk_320105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Survival in multiple myeloma has improved greatly during the past 2 decades, but this change has primarily benefited patients who have standard-risk disease. Patients with high-risk disease remain a challenge to diagnose and treat. To improve their clinical outcomes, it is imperative to develop tools to readily identify them and to provide them with the most effective available treatments. The most widely used stratification system, the revised International Staging System, incorporates serum β-2 microglobulin, albumin, lactate dehydrogenase, and high-risk chromosomal abnormalities [del(17p), t(4;14), and t(14;16)]. Recent updates have included mutational status and chromosome 1q abnormalities. Plasma cell leukemia, extramedullary disease, circulating plasma cells, renal failure, and frailty are also associated with poor outcome. The treatment approach for a newly diagnosed patient with high-risk multiple myeloma should include induction therapy, autologous stem cell transplantation if appropriate, and maintenance therapy. Triplet therapy with a proteasome inhibitor, immunomodulatory drug, and steroid, with or without an anti-CD38 antibody, should be considered for induction, along with a proteasome inhibitor and/or immunomodulatory drug for maintenance. Aiming for a deep and sustained response is important. Similar principles apply at relapse, with close monitoring of response, especially extramedullary disease and active management of side effects, so that patients can continue therapy and benefit from treatment. Immune-based therapies, including autologous CAR T-cell-based therapies and bispecific antibodies, show promising activity in relapsed disease and are being actively explored in earlier disease settings. As the prognosis for high-risk disease remains poor, the future goal for this patient group is to develop specific clinical trials to explore novel approaches and therapies efficiently.
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Affiliation(s)
- Jessica Caro
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | - Samer Al Hadidi
- Department of Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | - Saad Usmani
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC
| | - Andrew J Yee
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital, Boston, MA
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone Health, New York, NY
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Chaulagain CP, Diacovo MJ, Van A, Martinez F, Fu CL, Jimenez Jimenez AM, Ahmed W, Anwer F. Management of Primary Plasma Cell Leukemia Remains Challenging Even in the Era of Novel Agents. Clin Med Insights Blood Disord 2021; 14:2634853521999389. [PMID: 33716516 PMCID: PMC7917418 DOI: 10.1177/2634853521999389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Primary plasma cell leukemia (PCL) is a rare and aggressive variant of multiple myeloma (MM). PCL is characterized by peripheral blood involvement by malignant plasma cells and an aggressive clinical course leading to poor survival. There is considerable overlap between MM and PCL with respect to clinical, immunophenotypic, and cytogenetic features, but circulating plasma cell count exceeding 20% of peripheral blood leukocytes or an absolute plasma cell count of >2000/mm3 distinguishes it from MM. After initial stabilization and diagnosis confirmation, treatment of PCL in a fit patient typically includes induction combination chemotherapy containing novel agents typically, with proteasome inhibitors (such as bortezomib) and immunomodulatory drugs (eg, lenalidomide), followed by autologous hematopoietic stem cell transplant (HSCT) and multidrug maintenance therapy using novel agents post-HSCT. Long-term outcomes have improved employing this strategy but the prognosis for non-HSCT candidates remains poor and new approaches are needed for such PCL patients not eligible for HSCT. Here, we report a case of primary PCL, and a comprehensive and up to date review of the literature for diagnosis and management of PCL. We also present the findings of Positron Emission Tomography (PET) scan. Since PCL is often associated with extra-medulary disease, including PET scan at the time of staging and restaging may be a novel approach particularly to evaluate the extra-medullary disease sites.
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Affiliation(s)
- Chakra P Chaulagain
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Amy Van
- Department of Internal Medicine, Cleveland Clinic Florida, Weston FL, USA
| | - Felipe Martinez
- Department of Radiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Chieh-Lin Fu
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | - Antonio Martin Jimenez Jimenez
- Division of Stem Cell Transplant & Cell Therapy, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Wesam Ahmed
- Department of Hematology and Oncology, Maroone Cancer Center, Myeloma and Amyloidosis Program, Cleveland Clinic Florida, Weston, FL, USA
| | - Faiz Anwer
- Multiple Myeloma Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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A clinical perspective on plasma cell leukemia; current status and future directions. Blood Cancer J 2021; 11:23. [PMID: 33563906 PMCID: PMC7873074 DOI: 10.1038/s41408-021-00414-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive plasma cell disorder with a guarded prognosis. The diagnosis is confirmed when peripheral blood plasma cells (PCs) exceed 20% of white blood cells or 2000/μL. Emerging data demonstrates that patients with lower levels of circulating (PCs) have the same adverse prognosis, challenging the clinical disease definition, but supporting the adverse impact of circulating PCs. The cornerstone of treatment consists of combination therapy incorporating a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators as part of more-intensive chemotherapy, followed by consolidative autologous hematopoietic cell transplantation in eligible patients and then maintenance therapy. Monoclonal antibodies are also currently being evaluated in this setting with a strong rationale for their use based on their activity in multiple myeloma (MM). Due to limited therapeutic studies specifically evaluating pPCL, patients with pPCL should be considered for clinical trials. In contrast to MM, the outcomes of patients with pPCL have only modestly improved with novel therapies, and secondary PCL arising from MM in particular is associated with a dismal outlook. Newer drug combinations, immunotherapy, and cellular therapy are under investigation, and these approaches hopefully will demonstrate efficacy to improve the prognosis of pPCL.
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Lemieux C, Johnston LJ, Lowsky R, Muffly LS, Craig JK, Shiraz P, Rezvani A, Frank MJ, Weng WK, Meyer E, Shizuru J, Arai S, Negrin R, Miklos DB, Sidana S. Outcomes with Autologous or Allogeneic Stem Cell Transplantation in Patients with Plasma Cell Leukemia in the Era of Novel Agents. Biol Blood Marrow Transplant 2020; 26:e328-e332. [PMID: 32961371 DOI: 10.1016/j.bbmt.2020.08.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and very aggressive plasma cell disorder. The optimal treatment approach, including whether to pursue an autologous (auto) or allogeneic (allo) stem cell transplantation (SCT) is not clear, given the lack of clinical trial-based evidence. This single-center retrospective study describes the outcomes of 16 patients with PCL (n = 14 with primary PCL) who underwent either autoSCT (n = 9) or alloSCT (n = 7) for PCL in the era of novel agents, between 2007 and 2019. The median age of the cohort was 58 years. High-risk cytogenetics were found in 50% of the patients. All patients received a proteasome inhibitor and/or immunomodulatory drug-based regimen before transplantation. At the time of transplantation, 10 patients (62%) obtained at least a very good partial response (VGPR). The response after autoSCT (3 months) was at least a VGPR in 6 patients (67%; complete response [CR] in 5). All patients undergoing alloSCT achieved a CR at 3 months. Maintenance therapy was provided to 5 patients (56%) after autoSCT. The median progression-free survival after transplantation was 6 months in the autoSCT group, compared with 18 months in the alloSCT group (P = .09), and median overall survival (OS) after transplantation in the 2 groups was 19 months and 40 months, respectively (P = .41). The median OS from diagnosis was 27 months and 49 months, respectively (P = .50). Of the 11 deaths, 10 patients (91%) died of relapsed disease. AlloSCT was not observed to offer any significant survival advantage over autoSCT in PCL, in agreement with recent reports, and relapse remains the primary cause of death in these patients.
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Affiliation(s)
- Christopher Lemieux
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Laura J Johnston
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Lowsky
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Lori S Muffly
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Juliana K Craig
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Parveen Shiraz
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Andrew Rezvani
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Matthew J Frank
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Wen-Kai Weng
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Everett Meyer
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Judith Shizuru
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Sally Arai
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Robert Negrin
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - David B Miklos
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California
| | - Surbhi Sidana
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, California.
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Suska A, Vesole DH, Castillo JJ, Kumar SK, Parameswaran H, Mateos MV, Facon T, Gozzetti A, Mikala G, Szostek M, Mikhael J, Hajek R, Terpos E, Jurczyszyn A. Plasma Cell Leukemia - Facts and Controversies: More Questions than Answers? Clin Hematol Int 2020; 2:133-142. [PMID: 34595454 PMCID: PMC8432408 DOI: 10.2991/chi.k.200706.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive hematological malignancy characterized by an uncontrolled clonal proliferation of plasma cells (PCs) in the bone marrow and peripheral blood. PCL has been defined by an absolute number of circulating PCs exceeding 2.0 × 109/L and/or >20% PCs in the total leucocyte count. It is classified as primary PCL, which develops de novo, and secondary PCL, occurring at the late and advanced stages of multiple myeloma (MM). Primary and secondary PCL are clinically and biologically two distinct entities. After the diagnosis, treatment should be immediate and should include a proteasome inhibitor and immunomodulator-based combination regimens as induction, followed by stem cell transplantation (SCT) in transplant-eligible individuals who have cleared the peripheral blood of circulating PCs. Due to the rarity of the condition, there have been very few clinical trials. Furthermore, virtually all of the myeloma trials exclude patients with active PCL. The evaluation of response has been defined by the International Myeloma Working Group and consists of both acute leukemia and MM criteria. With conventional chemotherapy, the prognosis of primary PCL has been ominous, with reported overall survival (OS) ranging from 6.8 to 12.6 months. The use of novel agents and autologous SCT appears to be associated with deeper response and an improved survival, although it still remains low. The PCL prognostic index provides a simple score to risk-stratify PCL. The prognosis of secondary PCL is extremely poor, with OS of only 1 month.
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Affiliation(s)
- Anna Suska
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - David H Vesole
- The John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Maria V Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Gabor Mikala
- Department of Hematology and Stem Cell Transplantation, South-Pest Central Hospital, Natl. Inst. Hematol. Infectol, Budapest, Hungary
| | - Marta Szostek
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
| | - Joseph Mikhael
- Translational Genomics Research Institute, City of Hope Cancer Center, Phoenix, Arizona, USA
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kopernika 17, Krakow 31-501, Poland
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19
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Yu T, Xu Y, An G, Tai YT, Ho M, Li Z, Deng S, Zou D, Yu Z, Hao M, Anderson KC, Qiu L. Primary Plasma Cell Leukemia: Real-World Retrospective Study of 46 Patients From a Single-Center Study in China. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e652-e659. [PMID: 32624447 DOI: 10.1016/j.clml.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Primary plasma cell leukemia (PPCL) is a rare and aggressive plasma cell disorder. The use of novel agents, together with autologous stem cell transplantation, has improved survival outcome in PPCL. However, the prognosis is still very poor, and the optimal treatment remains an unmet clinical need. PATIENTS AND METHODS We studied the efficacy and prognostic impact of novel agents in 46 patients with PPCL patients at the Blood Diseases Hospital in China. We examined the impact of clinical and laboratory features, as well as therapies (bortezomib- and/or immunomodulatory drug-based therapies, chemotherapy) on survival and extent of clinical response, including progression-free survival and overall survival (OS). Progression-free survival and OS were assessed by the Kaplan-Meier method, and survival distributions were compared by log-rank test. RESULTS In our cohort of 46 PPCL patients, the median age at the time of diagnosis was 54 years. Overall response rate was 54% (25/46). The median (95% confidence interval) progression-free survival time was 6 (0-12.5) months, and OS time was 14 (4.6-23.4) months. The OS time was significantly longer in patients treated with bortezomib-based versus non-bortezomib-based therapies (median [95% confidence interval], 19 [9-28.9] vs. 5 [4-24] months; P = .019). CONCLUSION This large single-center study of PPCL supports the use of bortezomib-based therapies as frontline treatment in PPCL patients.
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Affiliation(s)
- Tengteng Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yu-Tzu Tai
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Matthew Ho
- UCD School of Medicine, College of Health and Agricultural Science and UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Zengjun Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China; Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuhui Deng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Dehui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Zhen Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Mu Hao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, LeBow Institute for Myeloma Therapeutics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
| | - Lugui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.
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20
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Treatment of primary plasma cell leukemia with high doses of cyclophosphamide, bortezomib, and dexamethasone followed by double autologous HSCT. Ann Hematol 2019; 99:207-209. [DOI: 10.1007/s00277-019-03885-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
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21
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Wang H, Zhou H, Zhang Z, Geng C, Chen W. Bortezomib-based Regimens Improve the Outcome of Patients with Primary or Secondary Plasma Cell Leukemia: A Retrospective Cohort Study. Turk J Haematol 2019; 37:91-97. [PMID: 31769277 PMCID: PMC7236418 DOI: 10.4274/tjh.galenos.2019.2019.0254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: The management experience for plasma cell leukemia (PCL) is still limited by PCL’s rare incidence and aggressive course. The goal of this study was to further identify the efficacy of bortezomib-containing regimens for PCL in Chinese patients. Materials and Methods: In this study, 56 consecutive PCL patients [14 primary PCL (pPCL) and 42 secondary PCL (sPCL) cases] were retrospectively enrolled and 42/56 patients received bortezomib-based regimens (BBRs), including 10/14 pPCL and 32/42 sPCL patients. The patients’ survival data, clinical information, and safety data were collected and analyzed. Results: In pPCL and sPCL patients, the overall response rate in the bortezomib group was 90.0% and 25.0%, respectively. The median progression-free survival from PCL diagnosis for pPCL and sPCL was 8.3 months vs. 2.9 months (p=0.043) and median overall survival (OS) from PCL diagnosis was 23.3 months vs. 4.0 months. The OS for patients receiving BBRs was significantly longer for both pPCL (8.3 vs. 1.2 months, p=0.002) and sPCL (4.3 vs. 1.1 months, p<0.001). In multivariate COX analysis, BBR treatment [p=0.008, hazard ratio (HR)=0.38, 95% confidence interval (CI)=0.19-0.77] and very good partial response or better (≥VGPR) (p=0.035, HR=0.19, 95% CI=0.04-0.74) were independent predictors of OS for sPCL patients. For pPCL patients, BBR predicted OS (p=0.029, HR=0.056, 95% CI=0.004-0.745) instead of ≥VGPR (p=0.272, HR=3.365, 95% CI=0.38-29.303). Conclusion: It was found that BBRs could significantly improve OS for both pPCL and sPCL patients.
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Affiliation(s)
| | | | | | - Chuanying Geng
- Workers Stadium South Road, Chaoyang District, Beijing, China
| | - Wenming Chen
- Chaoyang District, Hematology, Beijing, China Beijing
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Musto P, Statuto T, Valvano L, Grieco V, Nozza F, Vona G, Bochicchio GB, La Rocca F, D'Auria F. An update on biology, diagnosis and treatment of primary plasma cell leukemia. Expert Rev Hematol 2019; 12:245-253. [PMID: 30905220 DOI: 10.1080/17474086.2019.1598258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Primary plasma cell leukemia (PPCL) is one of the most aggressive hematological malignancies. The prognosis of PPCL patients remains poor, although some improvements have been made in recent years. Areas covered: In this review recent clinical and biological advances in PPCL are reported. Some recommendations for the practical management of these patients are provided, with a particular focus on the role of novel agents and transplant procedures. A brief description of the currently ongoing clinical trials with new drugs is also enclosed. Expert opinion: PPCL still represents a difficult challenge for all hematologists. Here the authors provide a personal view on how the current, generally unsatisfactory results in this neoplastic disorder could be improved. In particular, dedicated studies exploring alternative therapies are necessary and eagerly awaited. Such studies should possibly be based on new biological information that could be of help in identifying novel genetic biomarkers for risk stratification and new actionable molecular targets.
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Affiliation(s)
- Pellegrino Musto
- a Unit of Hematology and Stem Cell Transplantation , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy.,b Department of Hematology of Basilicata , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy.,c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Teodora Statuto
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Luciana Valvano
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Vitina Grieco
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Filomena Nozza
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Gabriella Vona
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | | | - Francesco La Rocca
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
| | - Fiorella D'Auria
- c Scientific Direction, Laboratory of Clinical Research and Advanced Diagnostics , IRCCS-CROB, Referral Cancer Center of Basilicata , Rionero in Vulture (Pz) , Italy
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Primary Plasma Cell Leukemia: A Retrospective Study of a Rare Disease From Tertiary Cancer Centre From India. Indian J Hematol Blood Transfus 2019; 35:649-654. [PMID: 31741616 DOI: 10.1007/s12288-019-01114-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/11/2019] [Indexed: 12/25/2022] Open
Abstract
Plasma cell leukemia (PCL) is an aggressive rare leukemic variant of multiple myeloma (MM). We aim to present 4 years data on clinical profile and treatment outcomes of Primary PCL (PPCL) patients treated at tertiary care cancer centre from Northern India. To analyse response and safety profile of a PPCL with or without stem cell transplantation. Retrospectively reviewed and analysed PPCL patient's data at our centre from January-2013 to June-2017. Total 11 PPCL patients diagnosed among 240 MM patients during study period. Eight were males. Only 10 patients were started on treatment. Four (n = 4/10) patients underwent stem cell transplantation. Overall response rate was 70% (n = 7). Eleven culture positive bacterial infections (bloodstream = 2, urinary tract = 3; pulmonary = 6) were recorded. Four patients had fungal infections. One patient had Herpes Zoster infection. Relapse rate of entire cohort was 50% (n = 5). Median PFS and OS of entire cohort was 11 months (95% confidence interval 6.3-15.6) and 21 months (95% C.I. 1-49.8) respectively. The estimated PFS and OS at 1 year of transplanted versus nontransplanted patients were 71% + 24% versus 0% (P = 0.96) and 71% + 24% versus 15% + 19% (P = 0.234) respectively. Treatment with PIs + IMAs followed by transplants (single/double) might improve depth and duration of remission and OS. Patients should be treated with indefinite maintenance therapy to control disease.
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Jurczyszyn A, Castillo JJ, Avivi I, Czepiel J, Davila J, Vij R, Fiala MA, Gozzetti A, Grząśko N, Milunovic V, Hus I, Mądry K, Waszczuk-Gajda A, Usnarska-Zubkiewicz L, Dębski J, Atilla E, Beksac M, Mele G, Sawicki W, Jayabalan D, Charliński G, Gyula Szabo A, Hajek R, Delforge M, Kopacz A, Fantl D, Waage A, Crusoe E, Hungria V, Richardson P, Laubach J, Guerrero-Garcia T, Liu J, Vesole DH. Secondary plasma cell leukemia: a multicenter retrospective study of 101 patients. Leuk Lymphoma 2018; 60:118-123. [DOI: 10.1080/10428194.2018.1473574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Artur Jurczyszyn
- Hematology Department, Jagiellonian University Medical College, Cracow, Poland
| | - Jorge J. Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Irit Avivi
- Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jacek Czepiel
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
| | - Julio Davila
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ravi Vij
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mark A. Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Norbert Grząśko
- Department of Hematology, St John’s Cancer Center, Lublin, Poland
- Department of Experimental Hematology, Medical University of Lublin, Lublin, Poland
| | - Vibor Milunovic
- Division of Hematology, Clinical Hospital Merkur, Zagreb, Croatia
| | - Iwona Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Mądry
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Anna Waszczuk-Gajda
- Department of Hematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dębski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Erden Atilla
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | - Meral Beksac
- Hematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | | | - Waldemar Sawicki
- Department of Internal Medicine and Hematology, Military Institute of Medicine, Warsaw, Poland
| | | | | | | | - Roman Hajek
- Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | | | - Dorotea Fantl
- Seccion Hematologia Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anders Waage
- Norwegian University of Science and Technology, St. Olav’s Hospital, Trondheim, Norway
| | - Edvan Crusoe
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Vania Hungria
- Hospital Universitario Professor Edgar Santos, Salvador, Brazil
| | - Paul Richardson
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jacob Laubach
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas Guerrero-Garcia
- Division of Hematology and Oncology, Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, Brighton, MA, USA
| | - Jieqi Liu
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David H. Vesole
- John Theurer Cancer Center, Myeloma Division, Hackensack University Medical Center, Hackensack, NJ, USA
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25
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Ganzel C, Rouvio O, Avivi I, Magen H, Jarchowsky O, Herzog K, Cohen Y, Tadmor T, Horwitz NA, Leiba M, Nagler A, Cohen Y, Bulvik S, Polliack A, Rowe JM, Gatt ME. Primary plasma cell leukemia in the era of novel agents for myeloma – a multicenter retrospective analysis of outcome. Leuk Res 2018; 68:9-14. [DOI: 10.1016/j.leukres.2018.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/28/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
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26
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Jurczyszyn A, Radocha J, Davila J, Fiala MA, Gozzetti A, Grząśko N, Robak P, Hus I, Waszczuk-Gajda A, Guzicka-Kazimierczak R, Atilla E, Mele G, Sawicki W, Jayabalan DS, Charliński G, Szabo AG, Hajek R, Delforge M, Kopacz A, Fantl D, Waage A, Avivi I, Rodzaj M, Leleu X, Richez V, Knopińska-Posłuszny W, Masternak A, Yee AJ, Barchnicka A, Druzd-Sitek A, Guerrero-Garcia T, Liu J, Vesole DH, Castillo JJ. Prognostic indicators in primary plasma cell leukaemia: a multicentre retrospective study of 117 patients. Br J Haematol 2018; 180:831-839. [PMID: 29315478 DOI: 10.1111/bjh.15092] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022]
Abstract
We report a multicentre retrospective study that analysed clinical characteristics and outcomes in 117 patients with primary plasma cell leukaemia (pPCL) treated at the participating institutions between January 2006 and December 2016. The median age at the time of pPCL diagnosis was 61 years. Ninety-eight patients were treated with novel agents, with an overall response rate of 78%. Fifty-five patients (64%) patients underwent upfront autologous stem cell transplantation (ASCT). The median follow-up time was 50 months (95% confidence interval [CI] 33; 76), with a median overall survival (OS) for the entire group of 23 months (95% CI 15; 34). The median OS time in patients who underwent upfront ASCT was 35 months (95% CI 24·3; 46) as compared to 13 months (95% CI 6·3; 35·8) in patients who did not receive ASCT (P = 0·001). Multivariate analyses identified age ≥60 years, platelet count ≤100 × 109 /l and peripheral blood plasma cell count ≥20 × 109 /l as independent predictors of worse survival. The median OS in patients with 0, 1 or 2-3 of these risk factors was 46, 27 and 12 months, respectively (P < 0·001). Our findings support the use of novel agents and ASCT as frontline treatment in patients with pPCL. The constructed prognostic score should be independently validated.
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Affiliation(s)
| | - Jakub Radocha
- 4th Department of Medicine - Haematology, Charles University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Julio Davila
- Hospital Universitario de Salamanca, Salamanca, Spain
| | - Mark A Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Norbert Grząśko
- Department of Haematology, St John's Cancer Centre, Lublin, Poland.,Department of Experimental Haematology, Medical University of Lublin, Lublin, Poland
| | - Paweł Robak
- Department of Haematology, Medical University of Lodz, Copernicus Memorial Hospital, Łódź, Poland
| | - Iwona Hus
- Department of Haematology and Bone Marrow Transplantation, Medical University of Lublin, Lublin, Poland
| | - Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | | | - Erden Atilla
- Haematology Department and Bone Marrow Transplantation Unit, Ankara University Medical School, Ankara, Turkey
| | | | - Waldemar Sawicki
- Dept. of Internal Medicine and Haematology, Military Institute of Medicine, Warsaw, Poland
| | | | | | - Agoston G Szabo
- Department of Medicine, Section of Haematology, Vejle, Denmark
| | - Roman Hajek
- University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Agnieszka Kopacz
- Department of Haematology, University of Rzeszów, Rzeszów, Poland
| | - Dorotea Fantl
- Seccion Hematologia Adultos, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anders Waage
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Irit Avivi
- Tel Aviv Medical Centre, Tel Aviv, Israel
| | - Marek Rodzaj
- Department of Haematology, State Hospital, Cracow, Poland
| | - Xavier Leleu
- Service d'Hematologie CHU, Hopital de la Miletrie, Poitiers, France
| | - Valentine Richez
- Ministry of Interior Hospital in Olsztyn with Warmia and Masuria Oncology Centre, Olsztyn, Poland
| | | | - Anna Masternak
- Department of Haematology, State Hospital, Opole, Poland
| | - Andrew J Yee
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Agnieszka Barchnicka
- Department of Doctoral Studies, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
| | | | - Thomas Guerrero-Garcia
- Division of Hematology and Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Brighton, MA, USA
| | - Jieqi Liu
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David H Vesole
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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27
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Nahi H, Genell A, Wålinder G, Uttervall K, Juliusson G, Karin F, Hansson M, Svensson R, Linder O, Carlson K, Björkstrand B, Kristinsson SY, Mellqvist UH, Blimark C, Turesson I. Incidence, characteristics, and outcome of solitary plasmacytoma and plasma cell leukemia. Population-based data from the Swedish Myeloma Register. Eur J Haematol 2017; 99:216-222. [PMID: 28544116 DOI: 10.1111/ejh.12907] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 01/16/2023]
Abstract
Solitary plasmacytoma (SP) and plasma cell leukemia (PCL) are uncommon (3-6%) types of plasma cell disease. The risk of progression to symptomatic multiple myeloma (MM) is probably important for the outcome of SP. PCL is rare and has a dismal outcome. In this study, we report on incidence and survival in PCL/SP, and progression to MM in SP, using the prospective observational Swedish Multiple Myeloma Register designed to document all newly diagnosed plasma cell diseases in Sweden since 2008. Both solitary bone plasmacytoma (SBP) (n=124) and extramedullary plasmacytoma (EMP) (n=67) have better overall survival (OS) than MM (n=3549). Progression to MM was higher in SBP than in EMP (35% and 7% at 2 years, respectively), but this did not translate into better survival in EMP. In spite of treatment developments, the OS of primary PCL is still dismal (median of 11 months, 0% at 5 years). Hence, there is a great need for diagnostic and treatment guidelines as well as prospective studies addressing the role for alternative treatment options, such as allogeneic stem cell transplantation and monoclonal antibodies in the treatment of PCL.
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Affiliation(s)
- Hareth Nahi
- Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Genell
- Regional Cancer Centre West, Gothenberg, Sweden
| | | | | | | | | | | | - Ronald Svensson
- Hematology, Linkoping University Hospital, Linkoping, Sweden
| | - Olle Linder
- Hematology, Örebro University Hospital, Örebro, Sweden
| | | | | | | | | | - Cecilie Blimark
- Hematology, Sahlgrenska University Hospital, Gothenburg, Sweden
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28
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Jung SH, Lee JJ, Kim K, Suh C, Yoon DH, Min CK, Sohn SK, Choi CW, Lee HS, Kim HJ, Shin HJ, Bang SM, Yoon SS, Park SK, Yhim HY, Kim MK, Jo JC, Mun YC, Lee JH, Kim JS. The role of frontline autologous stem cell transplantation for primary plasma cell leukemia: a retrospective multicenter study (KMM160). Oncotarget 2017; 8:79517-79526. [PMID: 29108331 PMCID: PMC5668064 DOI: 10.18632/oncotarget.18535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell neoplasm, with rapidly progressing clinical course. We evaluated the treatment status and survival outcomes of 69 Korean patients with pPCL. Of them, 59 patients were treated; 15 (25.4%) were treated initially with novel agent-based regimens with upfront autologous stem cell transplantation (ASCT), 7 (11.9%) with conventional chemotherapy with upfront ASCT, 21 (35.6%) with novel agent-based regimens only, and 16 (27.1%) were treated with conventional chemotherapy alone. Overall response rates after initial therapy were significantly higher in patients treated with novel agent-based regimens compared with those treated with conventional chemotherapies (75% vs. 43.4%, P = 0.026). Median progression-free survival (PFS) and overall survival (OS) were 12.2 months and 16.1 months, respectively. The median PFS of the four treatment groups–conventional chemotherapy alone, novel agents alone, conventional chemotherapy with ASCT, and novel agents with ASCT–were 1.2, 9.0, 10.5, and 26.4 months, respectively (P < 0.001); the median OS of the four treatment groups were 2.9, 12.3, 14.1, and 31.1 months, respectively (P < 0.001). The median OS was also significantly better in the patients with novel agents with ASCT versus other patients. In a multivariate analysis, an increased lactate dehydrogenase level, low albumin (< 3.5 g/dL), and non-CR after front-line treatment were independently associated with poor PFS and OS. In conclusion, the use of novel agent-based therapy with ASCT and achieving a deep response to front-line treatment are important in expecting improved PFS and OS in patients with pPCL.
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Affiliation(s)
- Sung-Hoon Jung
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Je-Jung Lee
- Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea
| | - Kihyun Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Min
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Kyun Sohn
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chul Won Choi
- Korea University School of Medicine, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Hyo Jung Kim
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ho-Jin Shin
- Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Mee Bang
- Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong Kyu Park
- Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Ho-Young Yhim
- Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Min Kyoung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jae-Cheol Jo
- Ulsan University Hospital, Ulsan, Republic of Korea
| | - Yeung-Chul Mun
- Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jin Seok Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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29
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Yamashita Y, Tamura S, Oiwa T, Kobata H, Kuriyama K, Mushino T, Murata S, Hosoi H, Nishikawa A, Hanaoka N, Sonoki T. Successful Intrathecal Chemotherapy Combined with Radiotherapy Followed by Pomalidomide and Low-Dose Dexamethasone Maintenance Therapy for a Primary Plasma Cell Leukemia Patient. Hematol Rep 2017; 9:6986. [PMID: 28286633 PMCID: PMC5337827 DOI: 10.4081/hr.2017.6986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 01/04/2023] Open
Abstract
Primary plasma cell leukemia (PPCL) is a rare aggressive variant of plasma cell disorder and frequently presents with extramedullary disease. Central nervous system (CNS) involvement with PPCL has an extremely poor prognosis. We describe a 46-year-old man with PPCL treated with a combination of lenalidomide, bortezomib, and dexamethasone as induction therapy following upfront allogeneic stem cell transplantation (allo-SCT). Despite achieving a very good partial response, the patient suffered from an isolated CNS relapse 12 months after allo-SCT. He was immediately started on concurrent intrathecal chemotherapy (IT) and cranial irradiation (RT). Subsequently, pomalidomide and low-dose dexamethasone (Pd) were given as maintenance therapy. He has been without CNS recurrence for more than 18 months. Our case suggests that concurrent IT and RT followed by Pd maintenance therapy may be an effective option to control CNS relapse of PPCL after allo-SCT.
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Affiliation(s)
- Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Takehiro Oiwa
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Hiroshi Kobata
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Kodai Kuriyama
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University , Wakayama, Japan
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30
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Neri A, Todoerti K, Lionetti M, Simeon V, Barbieri M, Nozza F, Vona G, Pompa A, Baldini L, Musto P. Primary plasma cell leukemia 2.0: advances in biology and clinical management. Expert Rev Hematol 2016; 9:1063-1073. [DOI: 10.1080/17474086.2016.1244002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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31
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Affiliation(s)
- Pellegrino Musto
- Istituto di Ricovero e Cura a Carattere Scientifico, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Pz), Italy
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32
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Braga CG, Rodrigues AR, Alves M, Portela C, Pinto L, Marques H. Plasma cell leukaemia. Porto Biomed J 2016; 1:49-51. [PMID: 32258549 DOI: 10.1016/j.pbj.2016.04.001] [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: 02/03/2015] [Accepted: 09/08/2015] [Indexed: 10/21/2022] Open
Abstract
Plasma cell leukaemia (PCL) is a rare and aggressive disease. Diagnosis is made when there are >2000/#mL circulating plasma cells in peripheral blood or plasmacytosis >20% of total leukocyte count. We report a case of a 51-year old man with generalized bone pain and constitutional symptoms. Blood peripheral smear revealed leukocytosis with 39% plasma cells. Bone marrow biopsy showed plasma cell invasion, which confirmed the diagnosis of PCL. Additionally, the patient had markers of advanced disease. Chemotherapy with vincristine, adriamycin and dexamethasone was started. Despite an initial favourable response, the patient died 2 months later due to an infectious complication. PCL has no established treatment and has a dismal prognosis, requiring the achievement of better data to improve the disease course.
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Affiliation(s)
| | | | - Marina Alves
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
| | | | - Luísa Pinto
- Serviço de Medicina Interna, Hospital de Braga, Braga, Portugal
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33
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Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol 2016; 34:2125-32. [PMID: 27114594 DOI: 10.1200/jco.2015.63.1929] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Primary plasma cell leukemia (pPCL) is a rare and aggressive malignancy with a poor prognosis. With conventional chemotherapy, patients typically die within 1 year. In all but one of the retrospective studies reported to date, bortezomib and lenalidomide seem to improve survival. We conducted a prospective phase II trial in patients with pPCL to assess the efficacy of an alternate regimen that combines standard chemotherapy, a proteasome inhibitor, and high-dose melphalan and autologous stem cell transplantation (HDM/ASCT) followed by either allogeneic transplantation or bortezomib/lenalidomide maintenance. PATIENTS AND METHODS Patients 70 years old and younger with newly diagnosed pPCL received four alternating cycles of bortezomib, dexamethasone plus doxorubicin or cyclophosphamide. Peripheral blood stem cells were collected from responding patients with < 1% of circulating plasma cells before HDM/ASCT. As consolidation, young patients received a reduced-intensity conditioning allograft, whereas the remaining patients underwent a second HDM/ASCT followed by 1 year of bortezomib, lenalidomide, dexamethasone. The primary end point was progression-free survival (PFS). RESULTS Forty patients (median age, 57 years; range, 27 to 71 years) were enrolled. The median follow-up was 28.7 months. In the intention-to-treat analysis, the median PFS and overall survival were 15.1 (95% CI, 8.4; -) and 36.3 (95% CI, 25.6; -) months, respectively. The overall response rate to induction was 69%. One patient underwent a syngeneic allograft and 25 HDM/ASCT (16 of whom subsequently received a reduced-intensity conditioning allograft and seven a second ASCT followed by maintenance). CONCLUSION In this prospective trial in patients with pPCL, we show that bortezomib, dexamethasone plus doxorubicin or cyclophosphamide induction followed by transplantation induces high response rates and appears to significantly improve PFS.
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Affiliation(s)
- Bruno Royer
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France.
| | - Stéphane Minvielle
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Momar Diouf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Murielle Roussel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lionel Karlin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Cyrille Hulin
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Bertrand Arnulf
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Margaret Macro
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvie Cailleres
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Annie Brion
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sabine Brechignac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Karim Belhadj
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marie Lorraine Chretien
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Marc Wetterwald
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Carine Chaleteix
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Mourad Tiab
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Xavier Leleu
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Frenzel
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Laurent Garderet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Sylvain Choquet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Gabriel Fuzibet
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Charles Dauriac
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Luc-Matthieu Forneker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Lotfi Benboubker
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Thierry Facon
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Philippe Moreau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Hervé Avet-Loiseau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
| | - Jean Pierre Marolleau
- Bruno Royer, Momar Diouf, and Jean Pierre Marolleau, University Hospital, Amiens; Stéphane Minvielle and Philippe Moreau, University Hospital; Stéphane Minvielle, Institut National de la Santé et de la Recherche Médicale U892, Nantes; Murielle Roussel and Hervé Avet-Loiseau, Institute Universitaire du Cancer de Toulouse Oncopole; Hervé Avet-Loiseau, University Hospital, Toulouse; Lionel Karlin, University Hospital, Lyon; Cyrille Hulin, University Hospital, Vandœuvre lès Nancy; Bertrand Arnulf, St Louis University Hospital; Laurent Frenzel, Necker University Hospital; Laurent Garderet, St Antoine University Hospital; Sylvain Choquet, La Pitié University Hospital, Paris; Margaret Macro, University Hospital, Caen; Sylvie Cailleres, General Hospital, Aix en Provence; Annie Brion, University Hospital, Besançon; Sabine Brechignac, University Hospital, Bobigny; Karim Belhadj, University Hospital, Creteil; Marie Lorraine Chretien, University Hospital, Dijon; Marc Wetterwald, General Hospital, Dunkerque; Carine Chaleteix, University Hospital, Clermont-Ferrand; Mourad Tiab, General Hospital, La Roche/Yon; Xavier Leleu, University Hospital, Poitiers; Jean Gabriel Fuzibet, University Department, Nice; Charles Dauriac, University Hospital, Rennes; Luc-Matthieu Forneker, University Hospital, Strasbourg; Lotfi Benboubker, University Hospital, Tours; and Thierry Facon, University Hospital, Lille, France
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Bommannan K, Sachdeva MUS, Malhotra P, Kumar N, Sharma P, Naseem S, Ahluwalia J, Das R, Varma N, Prakash G, Khadwal A, Srinivasan R, Varma S. Plasma cell leukemia in North India: retrospective analysis of a distinct clinicohematological entity from a tertiary care center and review of literature. Blood Res 2016; 51:23-30. [PMID: 27104188 PMCID: PMC4828524 DOI: 10.5045/br.2016.51.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 11/23/2022] Open
Abstract
Background Plasma cell leukemia (PCL) is a rare and aggressive plasma cell neoplasm. In PCL, clonal plasma cells comprise ≥20% of the peripheral blood (PB) leukocytes and/or the absolute clonal PB plasma cell count is ≥2×109/L. Primary PCL (PPCL) originates de novo, whereas, secondary PCL (SPCL) evolves from pre-existing multiple myeloma. Methods Clinicohematological features, immunophenotypic profile, and survival of PCL patients were analyzed retrospectively. Results Between January 2007 and December 2014, ten PPCL and four SPCL patients were investigated (8 PPCLs and 3 SPCLs had complete clinical data). All were North Indians, sharing common geography and ethnicity. Our cohort showed less frequent renal failure, more frequent hepatomegaly, and non-secretory type disease. In contrast to western literature, flow cytometric immunophenotyping of our cohort revealed altered expression of CD138 (67%), CD56 (33%), and CD20 (0%). With novel therapeutic agents, these PPCL patients had a median overall survival of 15 months. Conclusion We highlight that our PPCL patients from North India had distinct clinicohematological and immunophenotypic profiles. The significance of our findings must be tested in a larger patient cohort and must be supported by molecular and cytogenetic investigations to unmask possible significant effects on pathogenesis.
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Affiliation(s)
- Karthik Bommannan
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kumar
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shano Naseem
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematolog, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Iriuchishima H, Ozaki S, Konishi J, Matsumoto M, Murayama K, Nakamura F, Yamamoto G, Handa H, Saitoh T, Nagura E, Shimizu K, Nojima Y, Murakami H. Primary Plasma Cell Leukemia in the Era of Novel Agents: A Multicenter Study of the Japanese Society of Myeloma. Acta Haematol 2015; 135:113-21. [PMID: 26505781 DOI: 10.1159/000439424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022]
Abstract
We investigated the treatment and outcome of Japanese patients with primary plasma cell leukemia (pPCL) in the era of novel agents and analyzed the risk factors affecting survival. Among 3,318 patients with symptomatic multiple myeloma (MM), 38 patients were diagnosed with pPCL. The median overall survival (OS) of the pPCL patients was 2.85 years, which was significantly extended compared with that in previous reports. The proportion of patients treated with novel agents was 61%. The OS of the patients treated with novel agents was significantly extended compared with that of patients treated without novel agents according to the generalized Wilcoxon test (2.85 vs. 1.16 years, p = 0.049). This statistical finding suggests that treatment with novel agents could have prevented early death in the patients with pPCL. Age was the only statistically significant prognostic factor associated with an inferior OS (hazard ratio 4.57). Five patients received maintenance therapy with novel agents, and their OS tended to be longer than that of the other patients without maintenance (4.45 vs. 2.85 years). Unlike MM, OS for pPCL has not been improved significantly over the last decade, especially in elderly patients. Therefore, it is important to establish the treatment strategy, particularly after induction treatment.
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Affiliation(s)
- Hirono Iriuchishima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Molecular Classification and Pharmacogenetics of Primary Plasma Cell Leukemia: An Initial Approach toward Precision Medicine. Int J Mol Sci 2015; 16:17514-34. [PMID: 26263974 PMCID: PMC4581206 DOI: 10.3390/ijms160817514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/20/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma (MM) which may represent a valid model for high-risk MM. This disease is associated with a very poor prognosis, and unfortunately, it has not significantly improved during the last three decades. New high-throughput technologies have allowed a better understanding of the molecular basis of this disease and moved toward risk stratification, providing insights for targeted therapy studies. This knowledge, added to the pharmacogenetic profile of new and old agents in the analysis of efficacy and safety, could contribute to help clinical decisions move toward a precision medicine and a better clinical outcome for these patients. In this review, we describe the available literature concerning the genomic characterization and pharmacogenetics of plasma cell leukemia (PCL).
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Localized Relapse of Primary Plasma Cell Leukaemia in the Central Nervous System. Case Rep Hematol 2015; 2015:273565. [PMID: 26064713 PMCID: PMC4441999 DOI: 10.1155/2015/273565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022] Open
Abstract
Primary plasma cell leukaemia (pPCL) is a rare and aggressive form of plasma cell malignancies with a very poor prognosis. Compared to other plasma cell malignancies the tendency to extramedullary spread is increased; however central nervous system (CNS) involvement is rare and only reported in few cases. We report the case of a 61-year-old man who was diagnosed with pPCL and achieved a complete remission after autologous stem cell transplantation but had a relapse in the CNS without systemic disease.
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Plasma cell leukemia: Clinicopathologic, immunophenotypic and cytogenetic characteristics of 4 cases. Hematol Oncol Stem Cell Ther 2015; 8:71-7. [PMID: 25929729 DOI: 10.1016/j.hemonc.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/28/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022] Open
Abstract
Plasma cell leukemia (PCL) is a rare hematologic malignancy with very poor outcome. It is defined by the presence of >2 × 10(9)/L plasma cells or >20% plasmacytosis of the differential white cell count in the peripheral blood. Primary PCL is first diagnosed in the leukemic phase, while secondary PCL corresponds to the leukemic transformation of a previously diagnosed multiple myeloma (MM). The incidence of PCL ranges between 2-4% of patients with MM and 0.9% of patients with acute leukemia. In this case series, we describe the clinicopathologic, immunophenotypic, and cytogenetic findings of four patients diagnosed with PCL within a ten-year period (2002-2012) at King Faisal Specialist Hospital and Research Centre (General Organization), Riyadh, Saudi Arabia.
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Jelinek T, Kryukov F, Rihova L, Hajek R. Plasma cell leukemia: from biology to treatment. Eur J Haematol 2015; 95:16-26. [DOI: 10.1111/ejh.12533] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Tomas Jelinek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
| | - Fedor Kryukov
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
| | - Lucie Rihova
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
| | - Roman Hajek
- University Hospital Ostrava; Department of Haematooncology; Ostrava Czech Republic
- University of Ostrava; Faculty of Medicine; Ostrava Czech Republic
- University Hospital Brno; Department of Clinical Haematology; Brno Czech Republic
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Landsburg DJ, Vogl DT, Plastaras JP, Stadtmauer EA. Melphalan/Total Body Irradiation–Conditioned Myeloablative Allogeneic Hematopoietic Cell Transplantation for Patients With Primary Plasma Cell Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e225-8. [DOI: 10.1016/j.clml.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/16/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Majhi U, Murhekar K, Sundersingh S, Rajalekshmi KR. Primary plasma cell leukaemia with unusual presentations: a case series. Indian J Hematol Blood Transfus 2014; 30:390-3. [PMID: 25332628 DOI: 10.1007/s12288-014-0430-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/24/2014] [Indexed: 12/22/2022] Open
Abstract
We present here three cases of plasma cell dyscrasias; first case presenting as primary plasma cell leukemia showing unusual morphology and aberrant expression of myeloid markers; the second case presenting as plasma cell leukaemia with atypical plasma cells in peripheral blood and the third case presenting as myelomatous pleural effusion after treatment for myeloma.
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Affiliation(s)
- Urmila Majhi
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - Kanchan Murhekar
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - Shirley Sundersingh
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
| | - K R Rajalekshmi
- Department of Oncopathology, Cancer Institute (WIA), 38, Sardar Patel road, Chennai, 600036 India
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Gonsalves WI, Rajkumar SV, Gupta V, Morice WG, Timm MM, Singh PP, Dispenzieri A, Buadi FK, Lacy MQ, Kapoor P, Gertz MA, Kumar SK. Quantification of clonal circulating plasma cells in newly diagnosed multiple myeloma: implications for redefining high-risk myeloma. Leukemia 2014; 28:2060-5. [PMID: 24618735 DOI: 10.1038/leu.2014.98] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 12/22/2022]
Abstract
The presence of clonal circulating plasma cells (cPCs) is a marker of high-risk disease in all stages of monoclonal gammopathies. However, the prognostic utility of quantitating cPCs using multiparametric flow cytometry in multiple myeloma (MM) patients with current treatments is unknown. There were 157 consecutive patients with newly diagnosed MM seen at the Mayo Clinic, Rochester from 2009 to 2011 that had their peripheral blood evaluated for cPCs by multiparameter flow cytometry. Survival analysis was performed by the Kaplan-Meier method and differences assessed using the log-rank test. Using a receiver operating characteristics (ROC) analysis, ⩾400 cPCs were considered as the optimal cutoff for defining high-risk disease. The presence of ⩾400 cPCs was associated with higher plasma cell (PC) proliferation and adverse cytogenetics. The median time-to-next-treatment and overall survival (OS) in patients with ⩾400 cPCs (N=37, 24%) was 14 months and 32 months compared with 26 months and not reached for the rest (P<0.001). In a multivariable model, the presence of ⩾400 cPCs and older age adversely affected OS. Flow cytometry to quantify cPCs is a valuable test for risk stratifying newly diagnosed MM patients in the era of novel agents. Future studies are needed to determine its role in developing a risk-adapted treatment approach.
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Affiliation(s)
- W I Gonsalves
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S V Rajkumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - V Gupta
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W G Morice
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M M Timm
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P P Singh
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - A Dispenzieri
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - F K Buadi
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M Q Lacy
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - P Kapoor
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - M A Gertz
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - S K Kumar
- 1] Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Katodritou E, Terpos E, Kelaidi C, Kotsopoulou M, Delimpasi S, Kyrtsonis MC, Symeonidis A, Giannakoulas N, Stefanoudaki A, Christoulas D, Chatziaggelidou C, Gastari V, Spyridis N, Verrou E, Konstantinidou P, Zervas K, Dimopoulos MA. Treatment with bortezomib-based regimens improves overall response and predicts for survival in patients with primary or secondary plasma cell leukemia: Analysis of the Greek myeloma study group. Am J Hematol 2014; 89:145-50. [PMID: 24123068 DOI: 10.1002/ajh.23600] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/12/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, with poor outcome. Bortezomib-based regimens (BBR) are highly effective in myeloma, but there is limited information about their efficacy and safety in PCL. Thus, we retrospectively collected data from 42 consecutive PCL patients (25 with primary PCL-pPCL and 17 with secondary PCL-sPCL) to explore the role of BBR in this entity. BBR were administered in 29 of 42 patients, while 6 of 25 patients with pPCL underwent autologous transplantation. Objective response (≥partial response) was significantly higher in patients treated with BBR versus conventional therapies (69% vs. 30.8%, P = 0.04); 27.5% of patients treated with BBR achieved at least very good partial response (vgPR). The highest ORR was observed in pPCL patients treated with BBR (88.9%; ≥vgPR: 33.3%). In BBR-group, grade 3 of 4 hematological, neurological and renal toxicity and neutropenic infections were observed in 41.4%, 7%, 3.4%, and 31%, respectively. With a median follow-up of 51 months, median overall survival (OS) for patients treated with BBR versus conventional therapies was 13 versus 2 months (P < 0.007). Median OS of patients with pPCL and sPCL treated with BBR was 18 and 7 months, respectively (P < 0.001). In the multivariate analysis normal PLTs, treatment with BBR and high quality response were the only powerful predictors for survival. Our study carrying the longest reported median follow-up, demonstrated that treatment of PCL with BBR induces high response rates and prolongs survival over conventional therapies, regardless of additional autologous transplantation rescue or established high risk features, with manageable toxicity.
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Affiliation(s)
- Eirini Katodritou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Charikleia Kelaidi
- Hematology Department; General Hospital “G. Papanikolaou,”; Thessaloniki Greece
| | - Maria Kotsopoulou
- Hematology Department; General Anticancer Hospital “Metaxa,”; Athens Greece
| | - Sossana Delimpasi
- Hematology Department; General Hospital of Athens “Evangelismos,”; Athens Greece
| | - Marie-Christine Kyrtsonis
- First Department of Propedeutic/Internal Medicine; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | | | - Nikos Giannakoulas
- Hematology Department; University of Thessalia; School of Medicine; Larissa Greece
| | | | | | | | - Vassiliki Gastari
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Nikos Spyridis
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evgenia Verrou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | | | - Kostas Zervas
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
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Bidmos MA, Joubert S, van Jaarsveld MFPC, Louw VJ. Plasma cell leukaemia and HIV co-infection: profile of patients and experience at Universitas Academic Hospital in Bloemfontein, South Africa. Int J Hematol 2013; 98:672-80. [PMID: 24258709 DOI: 10.1007/s12185-013-1461-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
Plasma cell leukaemia (PCL) is a rare condition with high mortality. HIV-positive patients have a propensity to develop malignancy; however, the occurrence of PCL with HIV infection in South Africa has not been documented. We describe patients with PCL in Universitas Hospital in Bloemfontein, South Africa, and report two new cases of HIV infection concurrent with PCL. A retrospective case series of PCL patients (2006-2012) seen at our Clinical Haematology unit is reported. Patient files were used to obtain information. The median age of patients (n = 9) was 51 years, and 66.7 % of cases were of African ethnicity. The condition was equally distributed between genders. Two patients were HIV positive. Both received combination antiretroviral therapy. The diagnosis of PCL was usually made as an incidental finding, subsequently confirmed on bone marrow aspirate and trephine. Deranged haematological and biochemical parameters, including severe anaemia, hypoalbuminaemia, and hyper-cellular bone marrow, were observed. Only one patient improved markedly on treatment, and remains alive at the time of writing. PCL shows poor response to treatment and predominates among Africans. The small sample size made it difficult to determine whether co-infection with HIV was a coincidental finding or the two diseases are pathophysiologically linked.
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Affiliation(s)
- Mubarak Ariyo Bidmos
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Canada,
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Achkar WA, Wafa A, Aljapawe A, Othman MA, Alhourani E, Liehr T. Acquired del(9)(p22.3) in a primary plasma cell leukemia. Mol Cytogenet 2013; 6:33. [PMID: 23985162 PMCID: PMC3765975 DOI: 10.1186/1755-8166-6-33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/24/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder, accounting for 1-2% of all plasma cell neoplasms, characterized by the presence of >2 × 109/l of plasma cells circulating in the peripheral blood, and exists in two forms: primary PCL (pPCL, 60% of the cases), and secondary PCL (sPCL), the latter being a leukemic transformation in patients with a previously diagnosed multiple myeloma. PCL is an aggressive disease with poor prognosis and a short median survival of 7 months. RESULTS Here, we report a pPCL case with hepatosplenomegaly, anemia, thrombocytopenia, fever, fatigue, weight loss, and plasma cell count up to 60% in peripheral blood and 80% in bone marrow. Immunophenotype was compatible with PCL. A del(9)(p22.3) was characterized using banding cytogenetics and array-proven multicolor banding (aMCB), the latter being of enormous significance to characterize breakpoint regions in detail. CONCLUSION To the best of our knowledge, this is the first report of pPCL associated with a partially monosomy 9pter to 9p22.3 as a sole chromosomal abnormality.
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Affiliation(s)
- Walid Al Achkar
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, P.O. Box 6091, Damascus, Syria
| | - Abdulsamad Wafa
- Department of Molecular Biology and Biotechnology, Human Genetics Division, Atomic Energy Commission, P.O. Box 6091, Damascus, Syria
| | - Abdulmunim Aljapawe
- Department of Molecular Biology and Biotechnology, Mammalians Biology Division, Atomic Energy Commission, Damascus, Syria
| | - Moneeb Ak Othman
- Jena University Hospital, Institute of Human Genetics, Jena, Germany
| | - Eyad Alhourani
- Jena University Hospital, Institute of Human Genetics, Jena, Germany
| | - Thomas Liehr
- Jena University Hospital, Institute of Human Genetics, Jena, Germany
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Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia 2013; 28:222-5. [PMID: 23958922 DOI: 10.1038/leu.2013.241] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- P Musto
- Scientific Direction, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - V Simeon
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M C Martorelli
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - M T Petrucci
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - N Cascavilla
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - F Di Raimondo
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - T Caravita
- Department of Hematology, Azienda Ospedaliera S. Eugenio, Tor Vergata University, Rome, Italy
| | - F Morabito
- Hematology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - M Offidani
- Hematology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - A Olivieri
- Hematology and Medicine Clinic, Marche Polytechnic University, Ancona, Italy
| | - G Benevolo
- Hematology 2, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - R Mina
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Guariglia
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G D'Arena
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - G Mansueto
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - N Filardi
- Unit of Hematology, San Carlo Hospital, Potenza, Italy
| | - F Nobile
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - A Levi
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy
| | - A Falcone
- Division of Hematology and Stem Cell Transplantation, Casa Sollievo della Sofferenza, Istituto di Ricovero e Cura a Carattere Scientifico, San Giovanni Rotondo, Italy
| | - M Cavalli
- Division of Hematology, Department of Biomedical Sciences, Azienda Ospedaliera Ferrarotto, University of Catania, Catania, Italy
| | - G Pietrantuono
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - O Villani
- Unit of Hematology and Hemopoietic Stem Cell Transplantation, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - S Bringhen
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - P Omedè
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - R Lerose
- Pharmacy Unit, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - L Agnelli
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - K Todoerti
- Laboratory of Pre-clinical and Translational Research, Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture (Pz), Italy
| | - A Neri
- Department of Clinical Sciences and Community Health, University of Milan; Hematology 1, Fondazione Ca' Grande Ospedale Maggiore Policlinico, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - M Boccadoro
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
| | - A Palumbo
- Division of Hematology, University of Turin, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy
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49
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Nishihori T, Abu Kar SM, Baz R, Alsina M, Harousseau JL, Kharfan-Dabaja MA. Therapeutic Advances in the Treatment of Primary Plasma Cell Leukemia: A Focus on Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2013; 19:1144-51. [DOI: 10.1016/j.bbmt.2013.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
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50
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Fernández de Larrea C, Kyle RA, Durie BGM, Ludwig H, Usmani S, Vesole DH, Hajek R, San Miguel JF, Sezer O, Sonneveld P, Kumar SK, Mahindra A, Comenzo R, Palumbo A, Mazumber A, Anderson KC, Richardson PG, Badros AZ, Caers J, Cavo M, LeLeu X, Dimopoulos MA, Chim CS, Schots R, Noeul A, Fantl D, Mellqvist UH, Landgren O, Chanan-Khan A, Moreau P, Fonseca R, Merlini G, Lahuerta JJ, Bladé J, Orlowski RZ, Shah JJ. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia 2012; 27:780-91. [PMID: 23288300 DOI: 10.1038/leu.2012.336] [Citation(s) in RCA: 233] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma characterized by the presence of circulating plasma cells. It is classified as either primary PCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. Primary PCL is a distinct clinic-pathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. The diagnosis is based upon the percentage (≥ 20%) and absolute number (≥ 2 × 10(9)/l) of plasma cells in the peripheral blood. It is proposed that the thresholds for diagnosis be re-examined and consensus recommendations are made for diagnosis, as well as, response and progression criteria. Induction therapy needs to begin promptly and have high clinical activity leading to rapid disease control in an effort to minimize the risk of early death. Intensive chemotherapy regimens and bortezomib-based regimens are recommended followed by high-dose therapy with autologous stem cell transplantation if feasible. Allogeneic transplantation can be considered in younger patients. Prospective multicenter studies are required to provide revised definitions and better understanding of the pathogenesis of PCL.
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Affiliation(s)
- C Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain.
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