A Clinical Perspective on Plasma Cell Leukemia: A Single-Center Experience.
Andrew Y LiFarin KamangarNoa G HoltzmanAaron P RapoportMehmet H KocogluDjordje AtanackovicAshraf Z BadrosPublished in: Cancers (2024)
Circulating plasma cells (CPCs) are detected in most multiple myeloma (MM) patients, both at diagnosis and on relapse. A small subset, plasma cell leukemia (PCL), represents a different biology and has a poor prognosis. In this retrospective analysis, we evaluated patients with primary (pPCL, n = 35) or secondary (sPCL, n = 49), with ≥5% CPCs and a smaller subset with lower CPCs of 1-4% (n = 20). The median age was 61 years; 45% were men and 54% were Black. High-risk cytogenetics were found in 87% and extramedullary disease in 47%. For the entire cohort, 75% received a proteasome inhibitor, 70% chemotherapy, 54% an immunomodulatory drug, 24% a daratumumab-based regimen and 26% an autologous stem cell transplant (ASCT). The treatments marginally improved the overall survival (OS) for pPCL vs. sPCL (13 vs. 3.5 months p = 0.002). However, the 5-year survival for the whole cohort was dismal at 11%. High-risk cytogenetics, low platelets, extramedullary disease and high LDH were independently associated with poor outcomes. Further research is urgently needed to expand the treatment options and improve the outcomes in PCL.
Keyphrases
- poor prognosis
- multiple myeloma
- cell therapy
- stem cells
- bone marrow
- end stage renal disease
- single cell
- long non coding rna
- free survival
- acute myeloid leukemia
- induced apoptosis
- chronic kidney disease
- ejection fraction
- newly diagnosed
- prognostic factors
- emergency department
- oxidative stress
- peritoneal dialysis
- insulin resistance
- cell proliferation
- radiation therapy
- adverse drug
- red blood cell