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. 2019 Jul 23;14(7):e0219857.
doi: 10.1371/journal.pone.0219857. eCollection 2019.

Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era

F A Sharpley  1 , P Neffa  2 , F Panitsas  1 , J Kothari  1   3 , M Subesinghe  4 , D Cutter  1 , R Shcolnik Szor  2 , G Aparedcida Martinez  2 , V Rocha  1   2 , K Ramasamy  1   3
Affiliations

Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era

F A Sharpley et al. PLoS One. .

Erratum in

Abstract

Background: The risk of recurrence of solitary plasmacytoma (SP)/progression to MM is well established, but patient, imaging and treatment factors influencing risk of progression require further evaluation.

Methods: This is a retrospective analysis of 66 SP patients (23 UK, 43 Brazil) diagnosed 1989-2016. Patient baseline characteristics were recorded. The incidence of progression to MM was calculated, including biochemical and imaging findings and the treatment modality received. Survival estimates were determined by Kaplan-Meier analyses.

Results: With a median follow-up of 53.6 months the 5 year overall survival (OS) was 90.7% (95%CI 79-96%). The median progression free survival (PFS) from diagnosis was 61 months. Cumulative incidence of progression to MM was 49.9% at 5 years (95% CI 35.6-62.6%) and was significantly higher with bone plasmacytoma (47.2%, 95%CI 31.9-61.1%), than an extramedullary location (8.3%, 95%CI 0.4-32.3%, Gray test p = 0.0095)). The majority of patients with solitary bony plasmacytoma (SBP) received radiotherapy (RT) (51/53, 96.2%) whereas most extramedullary cases were treated with surgical resection (7/13, 53.8%). A small proportion of SBP patients received additional upfront chemotherapy, with 5/6 in remission after a median follow-up (FU) of 10 years. The diagnostic yield of surveillance functional FU imaging without other indications of relapse/progression was low. The positive predictive value of functional FU imaging was high but with a low negative predictive value, especially in cases of suspected relapse/progression.

Conclusion: Our data suggests functional imaging should be used if clinical suspicion of relapse/progression, rather than a routine surveillance tool, and upfront adjuvant chemotherapy is worthy of prospective evaluation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
(A) Cumulative Incidence of Multiple Myeloma (MM) by Solitary plasmacytoma type: EMD = extramedullary disease/plasmacytoma (B): The effect of plasmacytoma type on progression free survival (PFS): SBP = solitary bony plasmacytoma, EMD = extramedullar plasmacytoma.
Fig 2
Fig 2. How radiotherapy dose (radical >40Gy, or palliative <40Gy) affects progression free survival (PFS).
Fig 3
Fig 3
(A) SBP treatment pathways (B) EMP treatment pathways.
See this image and copyright information in PMC

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