Multiple Myeloma Treatment Information for Healthcare Professionals

Extramedullary Plasmacytoma

Patients with isolated plasma cell tumors of soft tissues, most commonly occurring in the tonsils, nasopharynx, or paranasal sinuses, should have skeletal x-rays and bone marrow biopsy (both of which should be negative), and evaluation for an M-protein in serum and urine.^1-3

The median survival of patients with extramedullary plasmacytomas treated with radiation therapy was 8.5 years in one study. However, most of these patients die from causes unrelated to the extramedullary plasmacytoma, without any evidence of progression of the plasma cell neoplasm at the time of death. The progression-free survival of the patients at risk was 70% at 14 years. In those who did progress, the most common site was the regional lymph nodes.²

Treatment options:

1. Tumoricidal radiation therapy to the isolated lesion with fields that cover the regional lymph nodes, if possible.
   
2. In rare cases, surgical resection may be considered, but it is usually followed by radiation therapy.
   
3. If the M-protein persists or reappears, the patient may need further therapy. In some patients, the plasmacytoma may shrink, but not disappear and the M-protein persists. These patients should be followed closely. Surgery should be performed if the plasmacytoma is in a site where it can be removed easily, e.g., in the tonsil; the M-protein may disappear from the blood or urine.
   
4. Chemotherapy is required if the disease progresses and causes symptoms.

References:

1. Meis JM, Butler JJ, Osborne BM, et al.: Solitary plasmacytomas of bone and extramedullary plasmacytomas: a clinicopathologic and immunohistochemical study. Cancer 59(8): 1475-1485, 1987.
2. Knowling MA, Harwood AR, Bergsagel DE: Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone. Journal of Clinical Oncology 1(4): 255-262, 1983.
3. Soesan M, Paccagnella A, Chiarion-Sileni V, et al.: Extramedullary plasmacytoma: clinical behaviour and response to treatment. Annals of Oncology 3(1): 51-57, 1992.

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