PLASMACYTOMA - TREATMENT RESULTS AND CONVERSION TO MYELOMA
PLASMACYTOMA - TREATMENT RESULTS AND CONVERSION TO MYELOMA
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DOI：
10.1002/1097-0142(19920315)69:6
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发表时间：
1992-03-15
期刊：
影响因子：
6.2
通讯作者：
FINEBERG, B
中科院分区：
文献类型：
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作者：
HOLLAND, J;TRENKNER, DA;FINEBERG, B
对46例孤立性浆细胞瘤的放射反应和进展为多发性骨髓瘤进行了回顾。其中孤立性骨浆细胞瘤32例，髓外浆细胞瘤14例。肿瘤对放射治疗的总有效率为93%：62%的肿瘤在放射治疗后完全有效，而31%的肿瘤部分有效。转化为多发性骨髓瘤受浆细胞瘤类型的影响；53%的SPB患者转化为骨髓瘤，而36%的EP患者转化为骨髓瘤。SPB患者从诊断到转换的时间没有显示出平台期的证据，即使在17年后，转换仍在继续发生。患者转化为骨髓瘤后的中位生存期为14.5个月，且不受转化时间的影响。血清蛋白水平、单克隆性伽马病的存在和原发病灶的大小对预测骨髓瘤的转归有一定的预后意义。辅助化疗并不影响转换的发生率，但似乎确实延迟了转换为骨髓瘤的时间。发生多个连续的孤立性浆细胞瘤的7名患者形成了一个不同的亚组，第二个浆细胞瘤的中位时间为63个月。在这些患者中，有三人随后转变为骨髓瘤。这项研究支持EP具有较低的骨髓瘤转化率和不同于SPB的自然病史的观点，SPB在进化过程中可能是多发性骨髓瘤。
Forty-six cases of solitary plasmacytoma were reviewed for response to radiation and progression to multiple myeloma. Cases were classified as solitary plasmacytomas of bone (SPB) (32 cases) or extramedullary plasmacytomas (EP) (14 cases). There was an overall 93% response rate of the tumor to radiation therapy: 62% had a complete response after radiation therapy, whereas 31% had a partial response. Conversion to multiple myeloma was influenced by the type of plasmacytoma; 53% of the patients with SPB converting to myeloma versus 36% of the patients with EP. Time from diagnosis to conversion for patients with SPB showed no evidence of plateau, with conversion continuing to occur even after 17 years. The median survival time for patients after conversion to myeloma was 14.5 months and was not affected by time to conversion. Serum protein level, presence of monoclonal gammopathy, and size of primary lesion were of some prognostic significance in predicting conversion to myeloma. Adjuvant chemotherapy did not affect the incidence of conversion but did appear to delay conversion to myeloma. Seven patients in whom multiple sequential solitary plasmacytomas developed formed a distinct subset, with a median time to a second plasmacytoma of 63 months. In three of these patients, conversion to myeloma occurred subsequently. This study supports the idea of EP having a lower incidence of conversion to myeloma and a different natural history from SPB, with SPB likely to be multiple myeloma in evolution.