背景:孤立性浆细胞瘤分为骨孤立性浆细胞瘤(SBP)和孤立性髓外(软组织块)浆细胞瘤,根据病变的部位。尽管放疗的局部控制率很高,大约一半的患者病情在诊断后3-5年内发展为多发性骨髓瘤(MM),SBP预后较差。
方法:我们回顾性评估了2008年至2021年中国某医院SBP患者的治疗和预后。这项回顾性研究招募了24名接受SBP治疗超过13年的患者。
结果:SBP最常见的部位是中轴骨骼和股骨。在11例(46%)患者中检测到M蛋白,其中8个(33%)有轻链,2(8%)具有免疫球蛋白Gκ,1(4%)具有免疫球蛋白Dκ。流式细胞术显示5例患者(21%)的骨髓受累很小。治疗包括化疗,手术,和放疗在18(75%),12(50%),9名(38%)患者,分别,其中13人(54%)接受综合治疗。在67.2个月的中位随访期内,9名患者(38%)在101.5个月的中位时间内发展为MM。5年和10年无进展生存率分别为67.3%和37.4%,分别。一名患者因肺炎而死亡,但没有进展,另一名患者因复发而死亡。
结论:这项研究证实了SBP进展为MM的高比率,表明需要辅助化疗来管理SBP。
BACKGROUND: A solitary plasmacytoma is classified into a solitary plasmacytoma of the bone (SBP) and a solitary extramedullary (soft tissue mass) plasmacytoma, based on the site of the lesion. Despite the high local control rate with radiotherapy, approximately half of patients\' conditions progress to multiple myeloma (MM) within 3-5 years after diagnosis, with SBP having a worse prognosis.
METHODS: We retrospectively assessed the treatment and outcomes of patients with SBP in a hospital in China from 2008 to 2021. Twenty-four patients treated over 13 years with SBP were enrolled in this retrospective study.
RESULTS: The most common sites for SBP were the axial skeleton and femur. The M protein was detected in 11 patients (46 %), of which 8 (33 %) had light chains, 2 (8 %) had immunoglobulin G kappa and 1 (4 %) had immunoglobulin D kappa. Flow cytometry revealed that 5 patients (21 %) had minimal bone marrow involvement. The treatment included chemotherapy, surgery, and radiotherapy in 18 (75 %), 12 (50 %), and 9 (38 %) patients, respectively, of whom 13 (54 %) received combined treatment. Over a median follow-up period of 67.2 months, 9 patients (38 %) developed MM in a median time of 101.5 months. The 5- and 10-year progression-free survival rates were 67.3 % and 37.4 %, respectively. One patient died due to pneumonia without progression and the other died due to relapse.
CONCLUSIONS: This study confirmed the high rate of progression of SBP to MM, indicating a need for adjunct chemotherapy for the management of SBP.