Title | The clinical and pathological features of plasma cell myeloma post solid organ transplantation. |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Ofori K, Soderquist CR, Murty VV, Park D, Vlad G, Leeman-Neill RJ, Lentzsch S, Alobeid B, Bhagat G |
Journal | Am J Hematol |
Volume | 95 |
Issue | 12 |
Pagination | 1531-1541 |
Date Published | 2020 Dec |
ISSN | 1096-8652 |
Keywords | Adult, Aged, Disease-Free Survival, Female, Follow-Up Studies, Humans, Leukemia, Plasma Cell, Male, Middle Aged, Organ Transplantation, Survival Rate |
Abstract | Plasma cell neoplasms (PCNs), comprising plasma cell myelomas (PCMs) and plasmacytomas, which occur after solid organ transplantation, represent rare subtypes of monomorphic post-transplant lymphoproliferative disorders (M-PTLDs). Data regarding the clinical and pathological features of post-transplant (PT)-PCMs are limited. To gain a better understanding of disease biology, we performed comprehensive immunophenotypic analysis, reviewed cytogenetic analysis results and evaluated clinical outcomes of PT-PCMs diagnosed and treated at our institution. Fifteen PT-PCM (M: F - 4:1) and two PT-MGUS (two males) cases were identified. The median age of PT-PCM patients was 68 years (29-79 years) and PCMs presented at a median of 9.7 years (0.5-24.7 years) after transplantation. The PT-PCMs accounted for 11.6% of all M-PTLDs and the period prevalence was 9/3108 (0.29%), 3/1071 (0.28%), 2/1345 (0.15%) and 1/878 (0.11%) post kidney, heart, liver and lung transplantation. Lytic bone disease was observed in 1/11 (9%) patients. Marrow plasma cell infiltration ranged from 10%-70% (median 20%), with 10/15 (67%) and 5/15 (33%) cases manifesting immature and plasmablastic morphology. The immunophenotype of all cases and cytogenetic abnormalities, identified in 60% of cases, were similar to multiple myeloma (MM) of immunocompetent individuals. All PT-PCMs were EBER negative. Ten of 11 (91%) patients with active MM were treated, all with proteasome inhibitor-based therapy. Treatment response and 5-year overall survival (54.5%) was comparable to MM of immunocompetent individuals. However, the survival of patients with plasmablastic PCMs was inferior to those with immature PCMs. 0ur findings indicate PT-PCMs to be predominantly late onset PTLDs that have similar clinicopathologic characteristics as conventional MM. |
DOI | 10.1002/ajh.25988 |
Alternate Journal | Am J Hematol |
PubMed ID | 32864761 |
Related Faculty:
Rebecca Leeman-Neill, M.D., Ph.D.