More than 20,000 new cases of myeloma are diagnosed in the United States each year. Multiple myeloma usually occurs in middle aged and older individuals. Statistics show that the mean age of individuals diagnosed with myeloma is 62 years for men and 61 years for women. Dramatic advances in treatment for multiple myeloma and plasmacytoma in the past several years have given many patients an improved outlook.
If you have been diagnosed with plasmacytoma, you probably have many questions about your disease, how it is likely to be treated, and what happens when treatment is completed. This treatment summary, which is based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™), will help you understand the best available treatments for plasmacytoma. Talk to your doctors about these therapies so that together you can decide on a cancer treatment plan that is right for you.
Background
Myeloma is a cancer of the immune system in which abnormal plasma cells are found in the bone marrow. Plasma cells are a type of white blood cells that normally produce antibodies to help fight infections. In myeloma, large numbers of abnormal plasma cells (myeloma cells) are produced, causing disruptions of normal bone marrow function, destruction of the surrounding bone, and production of excessive amounts of monoclonal protein called M-protein. Myeloma affects sites in the body where bone marrow is normally active, such as within the bones of the spine and the skull, pelvis, rib cage, and areas around the shoulders and hips
Plasmacytoma and multiple myeloma start as a single cell that has undergone a genetic change. It then divides again and again until there is a group of cells, all with the same genetic defect. These cells produce proteins in greater quantities than normal cells, making the blood thicker and causing a variety of problems. Monitoring the quantities of these proteins is one way to monitor the progress of the disease.
Plasmacytomas are tumors of the plasma cells that are located either in the bone (osseus plasmacytoma) or outside the bone (extraosseous plasmacytoma). Plasmacytoma that is localized to a single site is called solitary plasmacytoma; multiple plasmacytomas that occur throughout the body are called multiple myeloma. For information on multiple myeloma, see the NCCN Multiple Myeloma Treatment Summary for People with Cancer
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Diagnosis of Plasmacytoma
People with multiple myeloma may have symptoms that cause them to contact their doctors. Pain in the bones, especially in the back and ribs, or broken bones are common. Some patients report excessive thirst, frequent urination, unexplained weight loss, fatigue or weakness, or frequent infections. Some patients have nausea or vomiting. All of these symptoms can be related to other causes, but because these can also be serious, anyone who has any of these symptoms should discuss them with a doctor.
To diagnose plasmacytoma or multiple myeloma, the doctor will usually order a number of tests, including an examination of blood and urine samples; a skeletal survey (x-rays of all your bones); and a bone marrow biopsy. The doctor will order genetic tests on your bone marrow sample and blood to find out which chromosomal abnormality is present. Depending on your particular circumstances, the doctor may also recommend an MRI of your spine, a CT scan or PET/CT, a bone density test, and other blood tests. If you have only one area that has a possible tumor, the doctor may order a biopsy of that site.
Your doctor will diagnose whether you have plasmacytoma or multiple myeloma based on several things:
- Presence of 10% or more plasma cells in the bone marrow aspirate (biopsy sample)
- M-protein levels of 30 g/dL or higher in a urine or blood sample
- High calcium in the blood (which suggests bone loss), poor kidney function, anemia, or bone disease
Treatment of Plasmacytoma
No single treatment works for all patients, and recommendations on the best treatment vary from person to person. Your doctor will determine the best treatment plan for you based on the cancer stage and your symptoms, age, and general health.
Solitary plasmacytoma is a single tumor (clump of myeloma cells) occurring either in the bone or another organ. If you have solitary plasmacytoma, local therapy may cure the disease, but your doctor will likely recommend additional tests before recommending a local therapy, to make sure that the cancer has not spread to other sites in your body. Treatment of solitary plasmacytoma differs from that of multiple myeloma that has spread throughout your body.
For a solitary plasmacytoma in a bone (osseus plasmacytoma), usual treatment is radiation therapy to the tumor site. If you have a solitary plasmacytoma in an organ other than your bone (extraosseous plasmacytoma), the treatment will be radiation therapy to the tumor site, possibly with surgery to remove the tumor. These treatments have the potential to cure the disease.
Disease that has spread beyond a solitary plasmacytoma is called multiple myeloma. For more information about multiple myeloma and its treatment, please see the NCCN Multiple Myeloma Treatment Summary.
Your doctor should provide you with a written care plan explaining what treatments you will have, when they will occur, and what side effects you may experience. You will be asked to sign an informed consent document indicating that you have been told about your treatment and what to expect.
It is very important that you ask your doctor or nurse every question you have. Cancer and its treatment are complicated, and most patients have questions.
For example, radiation therapy has side effects. Some side effects can be anticipated, and you can get treatment to reduce their severity. Talk with your doctor about what to expect from your treatment and how these side effects can be prevented, reduced, managed, or eliminated. Also talk to your doctor about any side effects that you may experience once treatment starts. Treating side effects does not alter how effective therapy is, but it can make you feel better.
Life After Treatment for Plasmacytoma
After completion of your treatment for a solitary plasmacytoma, you will enter a period called follow-up. At this point, you transition from active therapy to having your doctor monitor your health. Typically, you will see your doctor at 3- to 6-month intervals, though these visits may be more frequent (every 4 weeks) for a while right after treatment, to monitor its effectiveness. At these visits, your doctor will perform a physical exam and blood and urine tests and discuss your health with you. Once a year or if you have symptoms, your doctor may also perform a bone survey. You will only need a bone marrow biopsy if you have symptoms or the blood tests suggest it is needed. Depending on your individual circumstances, your doctor may recommend additional imaging tests, such as an MRI or a PET/CT scan. These doctor visits and tests are designed to ensure your continued good health. In the event that your cancer recurs (comes back after treatment), your doctor will talk with you about further treatments.