"Solitary" myeloma of bone: a review of 12 cases.
About: This article is published in Cancer.The article was published on 1974-08-01 and is currently open access. It has received 60 citations till now.
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TL;DR: Initial staging can be quantitatively related to followup using tumor cell mass changes calculated from changes in M‐component production, and should lead to improved study design and analysis in large clinical trials of therapy for multiple myeloma.
Abstract: The presenting clinical features of 71 patients with multiple myeloma were correlated with myeloma cell mass (myeloma cells X 10(12)/m2 of body surface area) determined from measurements of monoclonal immunoglobulin (M-component) synthesis and metabolism. Bivariate correlation and multivariate regression analyses showed that myeloma cell mass could be accurately predicted from A) extent of bone lesions, B) hemoglobin level, C) serum calcium level, and D) M-component levels in serum and urine. Analyses of response to chemotherapy and survival indicated significant correlation with measured myeloma cell burden. The results were synthesized to produce a very reliable and useful clinical staging system with three tumor cell mass levels (Table 7). For clinical research purposes, multivariate regression equations were developed to predict optimally the exact myeloma cell mass. Thus, initial staging can be quantitatively related to followup using tumor cell mass changes calculated from changes in M-component production. Use of the clinical staging system sould provide better initial assessment and followup of individual patients, and should lead to improved study design and analysis in large clinical trials of therapy for multiple myeloma.
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16 Mar 1981
TL;DR: One of the most important aspects of orthopedics, bone pathology, has not attracted enough specialists worldwide to handle the complex problems, encountered daily, that only an expert and experienced pathologist is capable of resolving.
Abstract: In the past 50 years considerable progress has been made in orthopedics and traumatology. One of the principal reasons for these advances has undoubtedly been the separation of these specialties from general surgery. Alongside this development the number of those devoted to the study and treatment of locomotor disabilities, who could formerly be counted on the fingers of one hand-at least in our country-has multiplied by thousands and even more have subspecialized. This accelerated growth has encouraged the sharpen ing of diagnostic skills, technical improvement, and the application of advances in other fields of medicine to orthopedics. However, paradoxically enough, one of the most important aspects of orthopedics, bone pathology, has not attracted enough specialists worldwide to handle the complex problems, encountered daily, that only an expert and experienced pathologist is capable of resolving. Within the modern milieu, the personality and accomplishments of Professor Fritz Schajowicz stand out distinctly. Dr. Schajowicz, of Austrian origin, studied with Pro fessor J. Erdheim of Vienna. Having afterwards been granted a fellowship to extend his knowledge of bone pathology at the Rizzoli Orthopedic Institute of Bologna under the direction of Professor Vittorio Putti, he complemented this work with the study of clinical orthopedics at that prestigious institution. In 1938, Professor Jose Valls visited the Rizzoli Institute and, recognizing the outstanding training of Professor Schajowicz, invited him to move to Argentina where we were in need of an expert pathologist."
406 citations
TL;DR: In EMP patients the occurrence of involved lymph nodes at the time of diagnosis in seven, and initial relapse in regional nodes in three, suggest that consideration should be given to including regional lymph nodes in the radiation fields used to treat these patients.
Abstract: Patients with solitary osseous plasmacytomas (SOP) differ from those with extramedullary plasmacytomas (EMP) in that they are younger and the proportion of males is smaller. The median survival of the two groups is similar: 86.4 mo for SOP, and 100.8 mo for EMP. Progression-free survival, however, is much better for EMP. Only five EMP patients have progressed following initial radiation therapy: one developed a single bony lesion, two progressed to multiple myeloma, and two developed multiple EMP. Thus, 71% of EMP patients are progression free at 10 yr, and most deaths do not result from plasma cell neoplasia. In contrast, 13 SOP patients have progressed to develop additional osteolytic lesions, so that only 16% of SOP patients are progression free at 10 yr; death resulted from progression to multiple myeloma in most of these patients. In EMP patients the occurrence of involved lymph nodes at the time of diagnosis in seven, and initial relapse in regional nodes in three, suggest that consideration should ...
349 citations
TL;DR: The radiotherapy experience at M. D. Anderson Hospital is reviewed to confirm the better prognosis of EMPC and support the theory that SPB and EMPC are two different entities.
Abstract: Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMPC) are unusual solitary tumors of plasma cell origin. The clinical differences between these tumors and multiple myeloma are the subject of continued study. This review examines the radiotherapy experience at M. D. Anderson Hospital. Between 1948 and 1977, 12 patients with SPB and 12 patients with EMPC were treated with radiotherapy. Radiotherapeutic doses were most often (22/24) greater than 4,000 rads, at 200 rads per day. In order to qualify as solitary plasmacytoma a disease-free interval of 3 years was required. In the group of SPB, 5 patients of 9 were alive with no evidence of disease (NED) at 3 years, 4 of 5 at 5 years, and none of 4 at 10 years. In the EMPC group, 8 patients of 11 were NED at 3 and 5 years, and 6 of 9 at 10 years. Six patients with SPB developed multiple myeloma compared with only two with EMPC. The results confirm the better prognosis of EMPC and support the theory that SPB and EMPC are two different entities.
254 citations
TL;DR: It is concluded that solitary myeloma and multipleMyeloma are clearly different clinical entities; however, most patients with solitary Myeloma do eventually have multiple myelomas.
Abstract: Within plasma cell disorders, solitary myeloma is rare as compared with multiple myeloma. In order to evaluate their relationship, the clinical findings for 114 patients with solitary myeloma were compared with those for 70 patients having classic multiple myeloma. The period of follow up ranged from a few weeks to twenty-four years, and 68.5% of those with solitary myeloma alive at ten years. Although only 23% of patients with solitary myeloma had local or widespread recurrence after two years, at ten years 85% had experienced disease progression. Comparison of the 85% with disease progression with patients with multiple myeloma revealed that solitary myeloma occurred at a younger age (mean 52.1 years), more frequently in men (60.5%), less commonly with initial spinal involvement (61.8%), but more commonly with neurologic problems associated with spinal involvement (25%), and that much more commonly, no monoclonal component was detectable in serum and/or urine at the time of initial diagnosis (82.5%). There were only two significant differences between those patients with (85%) and without (15%) progression at ten years; the patients were younger (mean, 45.7 years) and spinal involvement (26.7%). However, was less common among patients without progression, and component monoclonal always disappeared following treatment with surgery and/or radiation therapy. It is thus concluded that solitary myeloma and multiple myeloma are clearly different clinical entities; however, most patients with solitary myeloma do eventually have multiple myeloma.
249 citations
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TL;DR: Pathologic Proteinuria and Renal Insufficiency Impairment of renal function, characterized by nitrogen retention in the absence of hypertension, occurs in over 50 per cent of cases of plasma-cell m...
Abstract: THE purpose of this article is primarily to review the more recent acquisitions to the knowledge and understanding of the pathophysiology of the plasma-cell dyscrasias. Several comprehensive studies of the clinical, radiographic, pathological and biochemical features of multiple myeloma have been published in the past thirty years.1 2 3 4 5 6 7 8 9 10 11 12 13 Major emphasis in this presentation, however, will be given to specific topics pertaining to plasma-cell neoplasia in which recent progress has been made. The "typical" case of multiple myeloma, if, indeed, such an entity exists, must now be considered as representing just one of several clinical patterns that may arise from a primary . . .
364 citations
TL;DR: A patient with plasma-cell myeloma was followed for thirty years and the main features of the case were: late onset of multiple bone lesions, paraproteinemia, responsiveness to radiotherapy, absence of Bence Jones proteinuria, and failure of diffuse Plasma-cell Myeloma to develop.
Abstract: A patient with plasma-cell myeloma was followed for thirty years. The main features of the case were: late onset of multiple bone lesions, paraproteinemia, responsiveness to radiotherapy, absence of Bence Jones proteinuria, and failure of diffuse plasma-cell myeloma to develop. Large doses of radiation do not eradicate these lesions.
12 citations
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TL;DR: In this paper, a 44-year-old man was admitted to the hospital because of the radiologic finding of a mass in the lung and had been well until 18 years previously, when pain developed in the r...
Abstract: Presentation of Case A 44-year-old man was admitted to the hospital because of the radiologic finding of a mass in the lung. He had been well until 18 years previously, when pain developed in the r...
5 citations
TL;DR: It is the opinion that long-term low dosage administration of melphalan is as effective in producing remissions and prolonging survival as the intermittent high dosage regimen.
Abstract: Forty-five patients with multiple myeloma were given long-term low dose melphalan therapy over a seven-year period. Melphalan was administered orally on a daily schedule of 0.05 mg/kg/day initially and then reduced to 0.015 to 0.03 mg/kg/day to maintain the white blood cell count at 3,000 cells/cu mm. Thirteen patients had significant improvement in all objective indexes, 4 had improvement in one or more objective indexes, 9 had symptomatic improvement, and 19 did not improve. The median survival from the onset of treatment to death for the groups with objective signs of improvement was 33.5 months, 20.0 months for the symptomatically improved group, and 5.6 months for nonresponders. On the basis of our results, it is our opinion that long-term low dosage administration of melphalan is as effective in producing remissions and prolonging survival as the intermittent high dosage regimen.
5 citations