Difference between revisions of "Plasma cell leukemia"
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{{TOC limit|limit=3}} | {{TOC limit|limit=3}} | ||
=Guidelines= | =Guidelines= | ||
| + | '''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.''' | ||
==EMN== | ==EMN== | ||
*'''2018:''' Gavriatopoulou et al. [https://doi.org/10.1038/s41375-018-0209-7 European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias] [https://pubmed.ncbi.nlm.nih.gov/30038381/ PubMed] | *'''2018:''' Gavriatopoulou et al. [https://doi.org/10.1038/s41375-018-0209-7 European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias] [https://pubmed.ncbi.nlm.nih.gov/30038381/ PubMed] | ||
==IMWG== | ==IMWG== | ||
| − | *'''2012:''' de Larrea et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112539/ Consensus Statement on Diagnostic Requirements, Response Criteria, and Treatment Recommendations by the International Myeloma Working Group (IMWG)] | + | *'''2012:''' de Larrea et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112539/ Consensus Statement on Diagnostic Requirements, Response Criteria, and Treatment Recommendations by the International Myeloma Working Group (IMWG)] [https://pubmed.ncbi.nlm.nih.gov/23288300/ PubMed] |
=First-line therapy= | =First-line therapy= | ||
| Line 44: | Line 45: | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
| − | *Royer et al. 2016, responding patients: [[# | + | *Royer et al. 2016, responding patients: [[#Melphalan_monotherapy.2C_then_auto_HSCT|High-dose melphalan & autologous HSCT]] consolidation |
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
| Line 76: | Line 77: | ||
<div class="toccolours" style="background-color:#cbd5e7"> | <div class="toccolours" style="background-color:#cbd5e7"> | ||
====Subsequent treatment==== | ====Subsequent treatment==== | ||
| − | *Musto et al. 2013, responding patients eligible for transplant: HSCT per center protocol | + | *Musto et al. 2013, responding patients eligible for transplant: HSCT consolidation per center protocol |
| − | *Musto et al. 2013, responding patients ineligible for transplant: [[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] x 4 (8 cycles total), then [[#Lenalidomide_monotherapy|lenalidomide]] maintenance | + | *Musto et al. 2013, responding patients ineligible for transplant: [[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] consolidation x 4 (8 cycles total), then [[#Lenalidomide_monotherapy|lenalidomide]] maintenance |
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
# Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [https://doi.org/10.1038/leu.2013.241 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/23958922/ PubMed] | # Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. [https://doi.org/10.1038/leu.2013.241 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/23958922/ PubMed] | ||
=Consolidation after first-line therapy= | =Consolidation after first-line therapy= | ||
| − | ==Melphalan, then auto HSCT {{#subobject:5cf2b0|Regimen=1}}== | + | ==Melphalan monotherapy, then auto HSCT {{#subobject:5cf2b0|Regimen=1}}== |
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:e8054d|Variant=1}}=== | ===Regimen {{#subobject:e8054d|Variant=1}}=== | ||
| − | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
| − | !style="width: | + | !style="width: 33%"|Study |
| − | !style="width: | + | !style="width: 33%"|Dates of enrollment |
| + | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1200/jco.2015.63.1929 Royer et al. 2016] | |[https://doi.org/10.1200/jco.2015.63.1929 Royer et al. 2016] | ||
| + | |2010-04 to 2013-07 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
| Line 95: | Line 98: | ||
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
| − | *[[#PAD.2FVCD|PAD alternating with VCD]] | + | *Upfront [[#PAD.2FVCD|PAD alternating with VCD]] |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
| Line 102: | Line 105: | ||
**65 years old or younger AND CrCl 30 mL/min/1.73m<sup>2</sup> or more: 200 mg/m<sup>2</sup> | **65 years old or younger AND CrCl 30 mL/min/1.73m<sup>2</sup> or more: 200 mg/m<sup>2</sup> | ||
**Older than 65 years old OR CrCl less than 30 mL/min/1.73m<sup>2</sup>: 140 mg/m<sup>2</sup> | **Older than 65 years old OR CrCl less than 30 mL/min/1.73m<sup>2</sup>: 140 mg/m<sup>2</sup> | ||
| + | '''1 or 2 courses''' | ||
</div></div> | </div></div> | ||
===References=== | ===References=== | ||
<!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. --> | <!-- Presented at the 55th American Society of Hematology Annual Meeting, New Orleans, LA, December 7-10, 2013, and the 40th Annual Meeting of the European Society for Blood and Marrow Transplantation, Milan, Italy, March 30 to April 2, 2014. --> | ||
# Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [https://doi.org/10.1200/jco.2015.63.1929 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/27114594/ PubMed] EudraCT 2009-016607-33 | # Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. [https://doi.org/10.1200/jco.2015.63.1929 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/27114594/ PubMed] EudraCT 2009-016607-33 | ||
| + | |||
=Maintenance after first-line therapy= | =Maintenance after first-line therapy= | ||
==Lenalidomide monotherapy {{#subobject:bec321|Regimen=1}}== | ==Lenalidomide monotherapy {{#subobject:bec321|Regimen=1}}== | ||
<div class="toccolours" style="background-color:#eeeeee"> | <div class="toccolours" style="background-color:#eeeeee"> | ||
===Regimen {{#subobject:45c352|Variant=1}}=== | ===Regimen {{#subobject:45c352|Variant=1}}=== | ||
| − | {| class="wikitable" style="width: | + | {| class="wikitable sortable" style="width: 60%; text-align:center;" |
| − | !style="width: | + | !style="width: 33%"|Study |
| − | !style="width: | + | !style="width: 33%"|Dates of enrollment |
| + | !style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
|- | |- | ||
|[https://doi.org/10.1038/leu.2013.241 Musto et al. 2013] | |[https://doi.org/10.1038/leu.2013.241 Musto et al. 2013] | ||
| + | |2009-03-01 to 2011-05-31 | ||
|style="background-color:#91cf61"|Phase 2 | |style="background-color:#91cf61"|Phase 2 | ||
|- | |- | ||
| Line 120: | Line 127: | ||
<div class="toccolours" style="background-color:#cbd5e8"> | <div class="toccolours" style="background-color:#cbd5e8"> | ||
====Preceding treatment==== | ====Preceding treatment==== | ||
| − | *[[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] x 8 | + | *Upfront [[#Lenalidomide_.26_Dexamethasone_.28Rd.29|Rd]] x 8 |
</div> | </div> | ||
<div class="toccolours" style="background-color:#b3e2cd"> | <div class="toccolours" style="background-color:#b3e2cd"> | ||
Latest revision as of 01:07, 18 May 2024
| Section editor | |
|---|---|
 |
Samuel M. Rubinstein, MD University of North Carolina Chapel Hill, NC, USA |
4 regimens on this page
4 variants on this page
|
Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
EMN
- 2018: Gavriatopoulou et al. European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias PubMed
IMWG
- 2012: de Larrea et al. Consensus Statement on Diagnostic Requirements, Response Criteria, and Treatment Recommendations by the International Myeloma Working Group (IMWG) PubMed
First-line therapy
PAD/VCD
PAD/VCD: PS-341 (Bortezomib), Adriamycin liposomal (Pegylated liposomal doxorubicin), Dexamethasone alternating with Velcade (Bortezomib), Cyclophosphamide, Dexamethasone
Regimen
| Study | Dates of enrollment | Evidence |
|---|---|---|
| Royer et al. 2016 | 2010-04 to 2013-07 | Phase 2 |
Targeted therapy, both portions (cycles 1 to 4)
- Bortezomib (Velcade) 1.3 mg/m2 SC once per day on days 1, 4, 8, 11
Chemotherapy, PAD portion (cycles 1 & 3)
- Pegylated liposomal doxorubicin (Doxil) 30 mg/m2 IV once on day 4
Chemotherapy, VCD portion (cycles 2 & 4)
- Cyclophosphamide (Cytoxan) 300 mg/m2 PO once per day on days 1 & 8
Glucocorticoid therapy, both portions (cycles 1 to 4)
- Dexamethasone (Decadron) 40 mg PO once per day on days 1, 4, 8, 11
21-day cycle for 4 cycles
Subsequent treatment
- Royer et al. 2016, responding patients: High-dose melphalan & autologous HSCT consolidation
References
- Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP; IFM. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. link to original article contains dosing details in manuscript PubMed EudraCT 2009-016607-33
Lenalidomide & Dexamethasone (Rd)
Rd: Revlimid (Lenalidomide) & low-dose dexamethasone
RevDex: Revlimid (Lenalidomide) & Dexamethasone
Ld: Lenalidomide & low-dose dexamethasone
LenDex: Lenalidomide & Dexamethasone
Regimen
| Study | Dates of enrollment | Evidence |
|---|---|---|
| Musto et al. 2013 | 2009-03-01 to 2011-05-31 | Phase 2 |
Targeted therapy
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1, 8, 15, 22
28-day cycle for 4 cycles
Subsequent treatment
- Musto et al. 2013, responding patients eligible for transplant: HSCT consolidation per center protocol
- Musto et al. 2013, responding patients ineligible for transplant: Rd consolidation x 4 (8 cycles total), then lenalidomide maintenance
References
- Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. link to original article contains dosing details in manuscript PubMed
Consolidation after first-line therapy
Melphalan monotherapy, then auto HSCT
Regimen
| Study | Dates of enrollment | Evidence |
|---|---|---|
| Royer et al. 2016 | 2010-04 to 2013-07 | Phase 2 |
Preceding treatment
- Upfront PAD alternating with VCD
Chemotherapy
- Melphalan (Alkeran) IV once (day not specified) by the following age- and renal function-based criteria:
- 65 years old or younger AND CrCl 30 mL/min/1.73m2 or more: 200 mg/m2
- Older than 65 years old OR CrCl less than 30 mL/min/1.73m2: 140 mg/m2
1 or 2 courses
References
- Royer B, Minvielle S, Diouf M, Roussel M, Karlin L, Hulin C, Arnulf B, Macro M, Cailleres S, Brion A, Brechignac S, Belhadj K, Chretien ML, Wetterwald M, Chaleteix C, Tiab M, Leleu X, Frenzel L, Garderet L, Choquet S, Fuzibet JG, Dauriac C, Forneker LM, Benboubker L, Facon T, Moreau P, Avet-Loiseau H, Marolleau JP. Bortezomib, Doxorubicin, Cyclophosphamide, Dexamethasone Induction Followed by Stem Cell Transplantation for Primary Plasma Cell Leukemia: A Prospective Phase II Study of the Intergroupe Francophone du Myélome. J Clin Oncol. 2016 Jun 20;34(18):2125-32. Epub 2016 Apr 25. link to original article contains dosing details in abstract PubMed EudraCT 2009-016607-33
Maintenance after first-line therapy
Lenalidomide monotherapy
Regimen
| Study | Dates of enrollment | Evidence |
|---|---|---|
| Musto et al. 2013 | 2009-03-01 to 2011-05-31 | Phase 2 |
Preceding treatment
- Upfront Rd x 8
References
- Musto P, Simeon V, Martorelli MC, Petrucci MT, Cascavilla N, Di Raimondo F, Caravita T, Morabito F, Offidani M, Olivieri A, Benevolo G, Mina R, Guariglia R, D'Arena G, Mansueto G, Filardi N, Nobile F, Levi A, Falcone A, Cavalli M, Pietrantuono G, Villani O, Bringhen S, Omedè P, Lerose R, Agnelli L, Todoerti K, Neri A, Boccadoro M, Palumbo A. Lenalidomide and low-dose dexamethasone for newly diagnosed primary plasma cell leukemia. Leukemia. 2014 Jan;28(1):222-5. Epub 2013 Aug 20. link to original article contains dosing details in manuscript PubMed