Progression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands.
Plasmacytoma is characterized by a local accumulation of monoclonal plasma cells without criteria for multiple myeloma (MM). The current treatment regimen is local radiotherapy. However, more than 50% of patients develop MM within 2 years after treatment. A population-based registry was consulted for the diagnosis of solitary plasmacytoma between 1988 and 2011. Progression to MM and prognostic features for progression to MM were scored, including hypoxia inducible factors (HIF), vascular endothelial growth factor (VEGF, also termed VEGFA) and micro-vessel density (MVD) expression in biopsy material. A total of 76 patients were included, 34% having extramedullary plasmacytoma (EMP) while 66% had a solitary plasmacytoma of the bone (SBP). Median follow-up was 89 months, (7-293 months). In Seventy per cent of SBP patients developed MM with a median time to progression of 19 months (5-293). Three patients (12%) with EMP developed MM. High expression of VEGF and HIF-2α (also termed EPAS1) was demonstrated in conjunction with an increased MVD in 66% of the patients. No association could be shown between angiogenesis parameters and progression to MM. In conclusion, this population-based study demonstrates that SBP patients have a higher risk of developing MM following local radiotherapy, indicating that this group might benefit from added systemic chemotherapy.
Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands.
Esther G M
EG
de Waal
Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands.
Marnix
M
Leene
Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Nic
N
Veeger
Department of Radiotherapy, Isala Clinics, Zwolle, The Netherlands.
Hanneke J
HJ
Vos
Department of Radiotherapy, Medical Spectrum Twente, Enschede, The Netherlands.
Francisca
F
Ong
Department of Radiotherapy, Radiotherapeutisch instituut Friesland, Leeuwarden, The Netherlands.
Wilma G J M
WG
Smit
Department of Haematology, Nij Smellinghe Hospital, Drachten, The Netherlands.
Sjoerd
S
Hovenga
Department of Haematology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
Mels
M
Hoogendoorn
Laboratory for Pathology East Netherlands Hengelo, Hengelo, The Netherlands.
Marieke
M
Hogenes
Department of Radiotherapy, University Medical Centre Groningen, Groningen, The Netherlands.
Max
M
Beijert
Department of Pathology, University Medical Centre Groningen, Groningen, The Netherlands.
Arjan
A
Diepstra
Department of Haematology, University Medical Centre Groningen, Groningen, The Netherlands.
Edo
E
Vellenga
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D051792:Basic Helix-Loop-Helix Proteins / Q000378:metabolism; D015415:Biomarkers; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000378:metabolism; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D010954:Plasmacytoma / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism / Q000628:therapy; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D000099162:Endothelial PAS Domain-Containing Protein 1
D051792:Basic Helix-Loop-Helix Proteins; D015415:Biomarkers; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D042461:Vascular Endothelial Growth Factor A; D000099162:Endothelial PAS Domain-Containing Protein 1
angiogenesis; extramedullary plasmacytoma; micro vessel density; multiple myeloma; solitary plasmacytoma of the bone