LY-08. Treatment of large plasmacytoma in patients with multiple myeloma (clinical case)

Summary

Сurrently, the multiple myeloma has moved from the category of incurable diseases to the category of chronic ones. The improvement in overall survival is associated with the inclusion of high-dose chemotherapy with subsequent autologous hematopoietic stem cell transplantation in treatment regimens, as well as new classes of drugs. Typically, in patients with multiple myeloma clonal plasma cell proliferation is limited to the bone marrow. However, some patients also develop extramedullary myeloma characterized by clonal plasma cells presence outside of bone marrow. As to clinical outcome, the presence of extramedullary plasmacytoma at the time of diagnosis is associated with poor prognosis. Relapse of the disease in the form of extramedullary plasmacytoma is characterized by a more aggressive course with an overall survival of less than 6 months. Radiation therapy, surgical treatment and systemic chemotherapy are used as treatment options, but the results of ones in patients with extramedullary plasmacytoma remain unsatisfactory, and innovative strategies are required.

Case report

A 65-year-old woman was diagnosed with IgG-lambda multiple myeloma in 2020. At diagnosis she presented with symptomatic myeloma-related bone lesions, and a bone marrow aspirate confirmed the presence of 99.3% clonal plasma cells. The International Scoring System (ISS) score was high (III). The first line of therapy consisted of 5 cycles of bortezomib-dexamethasone. The patient achieved a partial response (PR) after therapy completion. Three months after the last course of chemotherapy an extramedullary plasmacytoma of the left shoulder was diagnosed based on biopsy results. CT scan revealed a 127×110×45 mm lesion (Fig. 1a). One month later the patient was admitted to emergency department with massive bleeding from arterial branches feeding the tumor of the left shoulder. To stop the bleeding arteriography with embolization of the arteries of the upper extremities was performed. Under local anesthesia (sol.Novocaini 2.0%-10.0) a 5F introducer was inserted into the right femoral artery by puncture. Catheters: JR4 F5, Destination 5F (90 cm). Contrasting of the left subclavian artery was performed, arterial branches feeding the tumor of the left shoulders were revealed. Embolization was performed using EmboGold 700-900 microspheres. Control angiography confirmed optimal results (Fig. 1B, 1C). The radiation therapy was then started (33 Gy) in order to reduce the size of the tumor. 21 days after the radiation therapy control CT scan revealed a decrease in tumor size compared to the previous study (12×39×32 mm, Fig. 1D).

Conclusion

This clinical case demonstrates a possibility of successful combination (endovascular and radiation) therapy in treatment of a large extramedullary myeloma, which makes achieving a reduction in tumor size without increasing the dose and duration of radiation therapy possible. The use of endovascular methods in combination with radiotherapy or chemotherapy may be a promising area of modern oncohematology.

Keywords

Multiple myeloma, plasmocytoma, endovascular treatment.