Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
Division of Hematology, Hospital das Clinicas of the University of São Paulo, São Paulo, Brazil.
PLoS One. 2019 Jul 23;14(7):e0219857. doi: 10.1371/journal.pone.0219857. eCollection 2019.
The risk of recurrence of solitary plasmacytoma (SP)/progression to MM is well established, but patient, imaging and treatment factors influencing risk of progression require further evaluation.
This is a retrospective analysis of 66 SP patients (23 UK, 43 Brazil) diagnosed 1989-2016. Patient baseline characteristics were recorded. The incidence of progression to MM was calculated, including biochemical and imaging findings and the treatment modality received. Survival estimates were determined by Kaplan-Meier analyses.
With a median follow-up of 53.6 months the 5 year overall survival (OS) was 90.7% (95%CI 79-96%). The median progression free survival (PFS) from diagnosis was 61 months. Cumulative incidence of progression to MM was 49.9% at 5 years (95% CI 35.6-62.6%) and was significantly higher with bone plasmacytoma (47.2%, 95%CI 31.9-61.1%), than an extramedullary location (8.3%, 95%CI 0.4-32.3%, Gray test p = 0.0095)). The majority of patients with solitary bony plasmacytoma (SBP) received radiotherapy (RT) (51/53, 96.2%) whereas most extramedullary cases were treated with surgical resection (7/13, 53.8%). A small proportion of SBP patients received additional upfront chemotherapy, with 5/6 in remission after a median follow-up (FU) of 10 years. The diagnostic yield of surveillance functional FU imaging without other indications of relapse/progression was low. The positive predictive value of functional FU imaging was high but with a low negative predictive value, especially in cases of suspected relapse/progression.
Our data suggests functional imaging should be used if clinical suspicion of relapse/progression, rather than a routine surveillance tool, and upfront adjuvant chemotherapy is worthy of prospective evaluation.
孤立性浆细胞瘤（SP）/进展为多发性骨髓瘤（MM）的复发风险已得到充分证实，但影响进展风险的患者、影像学和治疗因素仍需进一步评估。
这是一项对 1989 年至 2016 年间诊断的 66 例 SP 患者（英国 23 例，巴西 43 例）的回顾性分析。记录患者的基线特征。计算进展为 MM 的发生率，包括生化和影像学发现以及所接受的治疗方式。通过 Kaplan-Meier 分析确定生存估计值。
中位随访 53.6 个月时，5 年总生存率（OS）为 90.7%（95%CI 79-96%）。从诊断到无进展生存期（PFS）的中位时间为 61 个月。5 年内进展为 MM 的累积发生率为 49.9%（95%CI 35.6-62.6%），且骨浆细胞瘤（47.2%，95%CI 31.9-61.1%）明显高于骨髓外位置（8.3%，95%CI 0.4-32.3%，Gray 检验 p = 0.0095）。大多数孤立性骨浆细胞瘤（SBP）患者接受了放射治疗（RT）（51/53，96.2%），而大多数骨髓外病例则接受了手术切除（7/13，53.8%）。一小部分 SBP 患者接受了额外的初始化疗，其中 6 例中有 5 例在中位随访 10 年后缓解。在没有其他复发/进展迹象的情况下，进行常规监测功能影像学检查的诊断效果较差。功能影像学检查的阳性预测值较高，但阴性预测值较低，尤其是在怀疑复发/进展的情况下。
我们的数据表明，如果怀疑复发/进展，应使用功能影像学检查，而不是常规监测工具，并且初始辅助化疗值得前瞻性评估。
