TREATMENT OF PRIMARY PLASMA CELL LEUKAEMIA
Background. The author describes long-term survival in 3 patients with primary plasma cell leukaemia (PL) after different therapeutic regimen and maintenance treatment with interferon alpha (INF).
Patients and treatment. In a 52-year-old male patient, a partial remission of PL was achieved after 6 months of treatment with melphalan and prednisone. The patient did not consent to stem cell transplantation (SCT). An 86-year-old female patient with PL achieved a complete remission after 6 months of treatment with vincristine, doxorubicin and dexamethasone. A 31-year-old male patient experienced a complete remission of PL after 6 months of treatment with cyclophosphamide, vincristine, doxorubicin, methilprednisone, followed by autologous SCT. All three patients were placed on maintenance therapy with INF-2b (Intron A) 3 × 106 IU given subcutaneously on two days per week. In the 52-year-old man, the remission lasted 9 months and in the woman 23 months, whereupon they developed a relapse with signs of disseminated plasmacytoma. In both patients the former chemotherapy was applied again, resulting in a slight improvement. The man died 37 months and the woman 43 months after the diagnosis of PL, while the youngest patient has been in complete remission for 82 months.
Conclusions. Long remission achieved in our patients confirmed the favourable effect of INF in terms of prolongation of the remission duration in this patients. The effect of maintenance treatment with INF is usually directly dependent on the degree of remission induced by different therapeutic regimen.
Gluzinski A, Reichenstein M. Myeloma and leucaemia lymphatica plasmocellularis. Wien Klin Wochenschr 1906; 19: 336–9.
Bernasconi C, Castelli G, Pagnucco G, Brusamolino E. Plasma cell leukemia: A report on 15 patients. Eur J Haematol 1989; 43: Suppl 51: 76B–83B.
Bichel J, Effersoe P, Gormsen H, Harboe N. Leukemic myelomatosis (plasma cell leukemia): A review with report of 4 cases. Acta Radiol 1952; 37: 196–207.
Kyle RA, Maldonado H, Bayrd FD. Plasma cell leukemia: Report on 17 cases. Arch Intern Med 1974; 133: 813–8.
Woodruff RK, Malpas JS, Paxton AM, Lister TA. Plasma cell leukemia (PCL): A report on 15 patients. Blood 1978; 52: 839–45.
Noel P, Kyle RA. Plasma cell leukemia: An evaluation of response to therapy. Am J Med 1987; 83: 1062–8.
Kosmo MA, Gale RP. Plasma cell leukemia. Sem Hematol 1987; 24: 202–8.
Panizo C, Rifon J, Rodriguez-Wilhelmi P, Cuesta B, Rocha E. Long-term survival in primary plasma cell leukemia after therapy with VAD, autologous blood stem cell transplantation and interferon-alpha. Acta Haematol 1999; 101: 193–6.
Yamagata N, Shimazaki C, Goto H et al. IgE plasma cell leukemia successfully treated with combination VAD and MP followed by interferon alfa. Am J Hematol 1992; 40: 226–8.
Mandelli F, Avvisati G, Amadori S et al. Maintenance treatment with recombinant interferon alfa-2b in patients with multiple myeloma responding to conventional induction chemotherapy. New Engl J Med 1990; 20: 1430–4.
Westin J. Interferon therapy during the plateau phase of multiple myeloma: an update of a Swedish multicenter study. Sem Oncol 1991; 27: Suppl 4: 45–8.
Černelč P, Mlakar U. Alpha interferon as maintenance therapy in primary plasma cell leukemia. Rev Invest Clin 1994; 4: Suppl 1: 275–5.
Čolovič M, Jankovič G, Suvajdžič N et al. Plasma cell leukemia-report on 10 cases. In: 24th Congress of the International Society of Haematology. London: Blackwell Scientific Publications, 1992: 122–2.
Pruzansky W, Platts ME, Ogryzlo MA. Leukemic form of immunocytic dyscrasia (plasma cell leukemia): A study of ten cases and a review of the literature. Am J Med 1969; 47: 60–74.
Osanto S, Mueller HP, Schuit HRE, Van Nieuwkoop JA, Willemze R. Primary plasma cell leukemia; A case report and a review of the literature. Acta Haematol 1983; 70: 122–9.
Montecucco C, Riccardi A, Merlini G, Ascari E. Complete remission in plasma cell leukaemia. Br J Haematol 1986; 62: 525–7.
McElwain TJ, Powles RL. High dose intravenous melphalan for plasma cell leukemia and myeloma. Lancet 1984; 2: 822–4.
Blade J, Lopez-Guillermo A, Tassies D, Monserat E, Rozman C. Development of aggressive plasma cell leukaemia under interferon-alfa therapy. Br J Haematol 1991; 79: 523–5.
Sawamura M, Murayama K, Ui G et al. Plasma cell leukaemia with alphainterferon therapy in myeloma. Br J Haematol 1992; 82: 631–1.
Shimizu S, Yoshoika R, Sugai S, Tachibana J, Konda S. Establishment of two interleukin-6 (b-cell stimulatory factor 2/interferon-beta 2) dependent human bone marrow derived myeloma cell lines. J Exp Med 1989; 169: 339–44.
Klein B, Zhang XG, Jourdan M et al. Interleukin-6 is the central tumor growth factor in vitro and in vivo in multiple myeloma. European Cytokine Network 1990; 1: 193–201.
Bjorkstrand B, Svensson H, Goldschmidt H et al. Alpha interferon maintenance treatment is associated with improved survival after high-dose treatment and autologous stem cell transplantation in patients with multiple myeloma: a retrospective registry study from EBMT. Bone Marrow Transplant 2001; 27: 511–5.
Singhal S, Mehta J, Desikan R et al. Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med 1999; 341: 1565–71.
Dalton WS, Bergsagel PL, Kuehl WM, Anderson KC, Harousseau JL. Multiple myeloma. In: Hematology 2001. Orlando: American Society of Hematology, 2001: 157–77.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.