585 Characteristics of Extramedullary Plasmacytomas in Patients Undergoing Autologous Transplant for Diagnosis of Multiple Myeloma in the Era of Triple Targeted Therapy

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Seema Naik, MD , Blood and Marrow Transplantation, Texas Transplant Institute, San Antonio, TX
Paul J. Shaughnessy, MD , Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX
Wilma Cain , Research, Texas Transplant Institute, San Antonio, TX
Jill McPhearson, DNP , Blood and marrow Transplantation, Texas Transplant Institute, San Antonio, TX
Barbara Rush, ADN, BA , Bone Marrow Transplant, Methodist Hospital, Boerne, TX
Ashley Simpson, PA-C , Pediatric Blood and Marrow Stem Cell Transplant, Texas Transplant Institute, San Antonio, TX
Behyar Zoghi, MD , Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX
Jose C Cruz, MD , Blood and marrow Transplantation, Texas Transplant Institute, San Antonio, TX
Carlos Bachier, MD , Adult Blood and Marrow Transplant, Texas Transplant Institute, San Antonio, TX
Presentation recording not available for download or distribution as requested by the presenting author.
Topic Significance & Study Purpose/Background/Rationale :Autologous stem cell transplant (ASCT) and various novel drug combination strategies are designed to improve outcome. Relapse within 12 months of stem cell transplant predicts poor outcome for patients with (MM). Historically, extramedullary plasmacytomas are not included in staging or as a prognostic feature for patients undergoing transplants for multiple myeloma.

Methods, Intervention, & Analysis :We evaluated characteristics of plasmacytomas (PCM) in patients undergoing ASCT transplant for diagnosis of MM. We retrospectively analyzed 251 consecutive (M137:F107) ASCT  for (MM)between December 2011 and June 2014, after new triple combination agents were introduced in the therapy of (MM). Median age was 57 years (38-76) and length of follow-up was 538 days (120 - 1042-days). Bone marrow cytogenetics was available in 230(94.3%) patients. Various pretransplant characteristics including age, cytogenetics, and plasma cell percentage were evaluated for impact on overall survival and disease progression.

A total of 159 (65%) patients had either extraosseous or extramedullary plasmacytomas at presentation and 85 (35%) patients had no lytic lesions or any plamacytomas. 52(21.3%) patients had extramedullary PCM without any lytic lesions. Plasma cells > 20% was seen in 38.2 %( n=20) in PCM compared to 62 %( n=152) in whole group. Prior MGUS (n=26) or smoldering myeloma (n=7) was seen in 14% (33/244) patients but only 7.6 %( 4/52) in PCM group. Prior solitary Plasmacytomas were seen in 21 %( 11/52) PCM patients. Trisomy 11 or t (11:14) was seen in 3 %( n=8) in PCM compared to 12 %( n=6) in all pts. Hyperdiploidy was seen in 4 %( 2/52) compared to 9 %( 22/244) patients.

Findings & Interpretation :The median survival was 623 days (20 days -1897 days) for PCM patients compared to 522 days (89 days -1897 days) for all patients. PCM pts developed recurrent PCM after autologous transplant in 33 %( 17/52) cases. One third of patients with recurrent PCM (6/17) died of (PCM) progression.

Discussion & Implications :In conclusion, patients presenting as PCM have more aggressive clinical presentation. Pre and Post transplant strategies need to be better defined to improve outcome of patients with PCM recurrences post transplant.

Disclosures:
P. J. Shaughnessy, Sanofi/Genzyme, Advisory Board: Advisory Board and Honoraria
Millennium, Advisory Board: Advisory Board and Honoraria
Pharmacyclics, Advisory Board: Advisory Board and Honoraria

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