Antineoplastics
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Reactions 1512, p8-9 - 2 Aug 2014 invasive procedure." "We propose that previous treatment(s), including novel agents and HSCT, combined with an active S Antineoplastics scar tissue inflammatory response, are responsible for this unusual presentation." Extramedullary plasmacytoma: 3 case reports Three patients with advanced stage multiple myeloma (MM) Muchtar E, et al. Myeloma in scar tissue - An underreported phenomenon or an developed extra-medullary plasmacytomas (EMP) [duration of emerging entity in the novel agents Era? A Single Center Series Acta Haematologica 132: 39-44, No. 1, Jun 2014. Available from: URL: http:// treatments to reaction onsets not stated] while receiving doi.org/10.1159/000354830 - Israel 803106231 antineoplastic agents [dosages and routes not stated]; they subsequently died [cause of death not clearly reported] A 71-year-old man received 9 courses of melphalan, prednisone and lenalidomide (MPR) and followed by15 courses of melphalan and prednisone (MP). Treatment was switched to lenalidomide and low-dose dexamethasone (Rd) due to disease progression. Several months later, he reported increasing pain in the left shoulder and he was diagnosed with a fracture of the neck of the humerus. He underwent internal fixation of the fracture using intra- medullary nailing. Several weeks later, his operated arm became progressively swollen. A CT scan showed a soft-tissue mass of 7cm invading the surgical scar. Fine-needle aspiration from the mass was consistent with EMP in the scar. His treatment with Rd was discontinued, and field irradiation was administered but the mass enlarged multiple subcutaneous nodules appeared on his affected arm and on his chest wall. Despite chemotherapy and radiotherapy additional soft-tissue EMP developed and his condition worsened. Ten months after the of initial documentation of EMP, he died with progressive renal failure. A 58-year-old man received 2 courses of bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (VDT-PACE) and achieved symptomatic relief. He underwent haematopoietic stem cell transplantation (HSCT) and achieved stringent complete remission; this was consolidated 6 courses of bortezomib, dexamethasone and thalidomide (VDT). PET-CT scan showed a residual para-sacral mass of 6 cm. Few months later, he experienced pelvic pain and an abdominal and pelvic CT scan showed re-expansion of the para-sacral mass. He was started on radiotherapy and VD (bortezomib and dexamethasone) due to deterioration in PET-CT findings the treatment was switched to 4 courses of bendamustine, lenalidomide and dexamethasone (BRd), but he did not respond; he subsequently underwent palliative de-bulking of the mass. Seven months later, while receiving weekly dexamethasone, he reported difficulty in walking. A purplish infiltration of the coccygeal edge of the surgical scar was noted. MRI showed a large mass in the para-sacral region with extension to the surgical scar at the coccyx edge. Biopsy of the mass in the scar area revealed monoclonal plasma cells with atypia, consistent with EMP in the surgical scar. Palliative radiotherapy was restarted and some improvement was noted. He developed systemic Nocardia infection which was treated with carbapenems and cotrimoxazole. He was treated with carfilzomib for disease progression but he died 6 months after recurrence in the scar tissue. A 52-year-old woman was treated with 2 courses of dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (DT-PACE) followed by HSCT. One year later, she received 4 courses of VD for disease relapse but due to no response her treatment was switched to VDT-PACE and again she underwent HSCT. She received 7 cycles of VD maintenance. She later developed a second relapse, and was treated with three different regimen lenalidomide + dexamethasone, cyclophosphamide + prednisone and bendamustine. However disease progression occurred as an exophytic mass of the mandibular gingiva was noted, near previous tooth extraction scar. Biopsy showed mucosal epithelium heavily infiltrated with immature monoclonal plasma cells, consistent with EMP. She was started on radiotherapy, but her condition worsened due to radiation-induced oral mucositis and progressive renal failure. She died 3 months after the initial presentation of oral EMP. Author comment: "We identified 3 MM patients presenting with relapsed EMP in a scar tissue from a recent 1 Reactions 2 Aug 2014 No. 1512 0114-9954/14/1512-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
Reactions 1512, p8-9 - 2 Aug 2014
invasive procedure." "We propose that previous treatment(s),including novel agents and HSCT, combined with an active SAntineoplastics scar tissue inflammatory response, are responsible for thisunusual presentation."Extramedullary plasmacytoma: 3 case reports
Three patients with advanced stage multiple myeloma (MM) Muchtar E, et al. Myeloma in scar tissue - An underreported phenomenon or andeveloped extra-medullary plasmacytomas (EMP) [duration of emerging entity in the novel agents Era? A Single Center Series Acta
Haematologica 132: 39-44, No. 1, Jun 2014. Available from: URL: http://treatments to reaction onsets not stated] while receivingdoi.org/10.1159/000354830 - Israel 803106231antineoplastic agents [dosages and routes not stated]; they
subsequently died [cause of death not clearly reported]A 71-year-old man received 9 courses of melphalan,
prednisone and lenalidomide (MPR) and followedby15 courses of melphalan and prednisone (MP). Treatmentwas switched to lenalidomide and low-dose dexamethasone(Rd) due to disease progression. Several months later, hereported increasing pain in the left shoulder and he wasdiagnosed with a fracture of the neck of the humerus. Heunderwent internal fixation of the fracture using intra-medullary nailing. Several weeks later, his operated armbecame progressively swollen. A CT scan showed a soft-tissuemass of 7cm invading the surgical scar. Fine-needle aspirationfrom the mass was consistent with EMP in the scar. Histreatment with Rd was discontinued, and field irradiation wasadministered but the mass enlarged multiple subcutaneousnodules appeared on his affected arm and on his chest wall.Despite chemotherapy and radiotherapy additional soft-tissueEMP developed and his condition worsened. Ten months afterthe of initial documentation of EMP, he died with progressiverenal failure.
A 58-year-old man received 2 courses of bortezomib,dexamethasone, thalidomide, cisplatin, doxorubicin,cyclophosphamide and etoposide (VDT-PACE) and achievedsymptomatic relief. He underwent haematopoietic stem celltransplantation (HSCT) and achieved stringent completeremission; this was consolidated 6 courses of bortezomib,dexamethasone and thalidomide (VDT). PET-CT scan showeda residual para-sacral mass of 6 cm. Few months later, heexperienced pelvic pain and an abdominal and pelvic CT scanshowed re-expansion of the para-sacral mass. He was startedon radiotherapy and VD (bortezomib and dexamethasone) dueto deterioration in PET-CT findings the treatment was switchedto 4 courses of bendamustine, lenalidomide anddexamethasone (BRd), but he did not respond; hesubsequently underwent palliative de-bulking of the mass.Seven months later, while receiving weekly dexamethasone,he reported difficulty in walking. A purplish infiltration of thecoccygeal edge of the surgical scar was noted. MRI showed alarge mass in the para-sacral region with extension to thesurgical scar at the coccyx edge. Biopsy of the mass in the scararea revealed monoclonal plasma cells with atypia, consistentwith EMP in the surgical scar. Palliative radiotherapy wasrestarted and some improvement was noted. He developedsystemic Nocardia infection which was treated withcarbapenems and cotrimoxazole. He was treated withcarfilzomib for disease progression but he died 6 months afterrecurrence in the scar tissue.
A 52-year-old woman was treated with 2 courses ofdexamethasone, thalidomide, cisplatin, doxorubicin,cyclophosphamide and etoposide (DT-PACE) followed byHSCT. One year later, she received 4 courses of VD for diseaserelapse but due to no response her treatment was switched toVDT-PACE and again she underwent HSCT. She received7 cycles of VD maintenance. She later developed a secondrelapse, and was treated with three different regimenlenalidomide + dexamethasone, cyclophosphamide +prednisone and bendamustine. However disease progressionoccurred as an exophytic mass of the mandibular gingiva wasnoted, near previous tooth extraction scar. Biopsy showedmucosal epithelium heavily infiltrated with immaturemonoclonal plasma cells, consistent with EMP. She wasstarted on radiotherapy, but her condition worsened due toradiation-induced oral mucositis and progressive renal failure.She died 3 months after the initial presentation of oral EMP.
Author comment: "We identified 3 MM patientspresenting with relapsed EMP in a scar tissue from a recent
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Reactions 2 Aug 2014 No. 15120114-9954/14/1512-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
