Treatment of Multiple Myeloma Presenting as Solitary Plasmacytoma
Clinical Scenario
Solitary plasmacytoma is an infrequent form of plasma cell neoplasm presenting as a single mass of monoclonal plasma cells — either in soft tissue (extramedullary) or within bone (intraosseous). This scenario represents a distinct clinical situation within the multiple myeloma spectrum, requiring careful staging before any treatment is initiated.
Treatment Approach (Partial Overview)
When the lesion is confirmed as truly solitary, a form of local high-dose radiation is generally the preferred first-line approach — though results from bone marrow assessment and whole-body imaging are required before the plan is finalised, and may point toward a different strategy entirely. The complete decision framework is in the structured protocol.
References
DOI: 10.1016/j.annonc.2020.11.014
- Solitary plasmacytoma is an infrequent form of plasma cell neoplasm that presents as a single mass of monoclonal plasma cells, with either extramedullary or intraosseous location.
- Local high-dose RT is the preferred treatment of choice [II, A], but about two-thirds of patients develop MM at 10 years' follow-up.
- Before treatment initiation, whole-body magnetic resonance imaging (MRI) and PET-CT should be carried out to exclude the presence of multiple plasmacytomas, commending systemic treatment instead of radiotherapy (RT) [I, A].
- Thus, detection of clonal PC using sensitive techniques in the BM is suggested [II, B] and systemic treatment of myeloma should be considered in these patients [III, B].
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