A Clinical Perspective on Plasma Cell Leukemia: A Single-Center Experience

Author:

Li Andrew Y.1,Kamangar Farin2ORCID,Holtzman Noa G.3,Rapoport Aaron P.1ORCID,Kocoglu Mehmet H.1,Atanackovic Djordje1,Badros Ashraf Z.14

Affiliation:

1. University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA

2. Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD 21251, USA

3. University of Miami Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA

4. Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA

Abstract

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.

Publisher

MDPI AG

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