SHORT SYSTEMIC TREATMENT CONCURRENT WITH INTENSITY-MODULATED RADIOTHERAPY BY TOMOTHERAPY (IMRT) SHOWS IMPROVEMENT OF PROGRESSION-FREE SURVIVAL IN SOLITARY PLASMACYTOMA OF THE BONE (SPB)
(Abstract release date: 05/19/16)
EHA Library. Le Ray E. 06/09/16; 132868; E1319
Disclosure(s): No competing interests
Dr. Emmanuelle Le Ray
Contributions
Contributions
Abstract
Abstract: E1319
Type: Eposter Presentation
Background
SPB is a rare plasma cell dyscrasia characterized by a single bone tumor without evidence of multiple myeloma. Standard treatment is currently local 40Gy radiotherapy. Local control is achieved in more than 90% of patients. However, approximately half of the patients develop further disease progression, be it a new plasmacytoma or multiple myeloma.
Aims
To determine the impact and tolerance of short-term treatment with Immunomodulatory Drugs (ImIDs) or proteasome inhibitors (PI) in association with 40 Gy IMRT on the progression-free survival of SPB patients.
Methods
We retrospectively reviewed the medical and dosimetric records of all patients treated for solitary plasmacytoma of the bone at a single institution between 2004 and 2013. All patients had histologically proven plasmacytoma of the bone, without bone marrow involvement. Initial evaluation included clinical examination, biological tests and radiological exams. The absence of additional lesions was assessed by standard radiographies associated with a more sensitive technique such as total body MRI, CT-scan and/or PET-CT. Radiotherapy modalities were reviewed. Additional treatment was assessed. Toxicity was evaluated weekly during radiotherapy, then at 6 weeks, 4 months and 1 year using CTCAEv3.0. Local control of the lesion was defined as negativation of PET-CT. Progression was defined as the incidence of a new plasmacytoma or a multiple myeloma. Statistical analysis: Progression-Free Survival (PFS) was defined as the period from the beginning of radiotherapy to the first documentation of progression or death. Patients alive without progression were censored at the date of last known contact. PFS was estimated using the Kaplan Meier method and compared with the log-rank test.
Results
28 patients were analyzed. Median age was 53.5y. Median follow-up was 52.2 months (7-99). 15 patients received the standard treatment, a local 40Gy radiotherapy (group 1); 13 patients (46%) received treatment with IMiDs or PIs, in addition to the 40 Gy local radiotherapy delivered by IMRT (group 2). In group 2, 9 patients (69%) received 4 cycles of lenalidomide+dexamethasone, of whom 2 also received bortezomib (15%); 3 received bortezomib+dex for 4 cycles (23%); and 1 received thalidomide for 12 months (7.5%) There was no significant difference between subgroups by conventional prognostic factors such as age, localization, M-Spike and ECOG. Toxicity was mostly hematological and manageable with standard approaches. 1 patient developed profound venous thrombosis on lenalidomide treatment in spite of aspirin prophylaxis.All patients achieved local control. Overall survival was more than 95% at 4 years. 1 patient died of disease progression (MM) in group 1. In group 1, 5 patients (33%) developed SPB and 5 patients developed multiple myeloma (33%) during follow-up, versus 1 SPB (7.5%) and 1 MM (7.5%) in group 2. PFS rates at 48 months were 50.3% CI95% [29.8 ;84.6] in group 1 and 80.0% CI95% [58.7 ;100] in group 2. PFS was significantly different between groups (p=0.032).
Conclusion
An additional treatment with IMiDs or PI to 40 Gy IMRT is well tolerated and allows prolonged progression-free survival for solitary plasmacytoma of the bone patients. These results need to be confirmed in a larger, standardized clinical trial.
Session topic: E-poster
Keyword(s): Immunomodulatory thalidomide analog, Plasma cells, Radiotherapy, Therapy
Type: Eposter Presentation
Background
SPB is a rare plasma cell dyscrasia characterized by a single bone tumor without evidence of multiple myeloma. Standard treatment is currently local 40Gy radiotherapy. Local control is achieved in more than 90% of patients. However, approximately half of the patients develop further disease progression, be it a new plasmacytoma or multiple myeloma.
Aims
To determine the impact and tolerance of short-term treatment with Immunomodulatory Drugs (ImIDs) or proteasome inhibitors (PI) in association with 40 Gy IMRT on the progression-free survival of SPB patients.
Methods
We retrospectively reviewed the medical and dosimetric records of all patients treated for solitary plasmacytoma of the bone at a single institution between 2004 and 2013. All patients had histologically proven plasmacytoma of the bone, without bone marrow involvement. Initial evaluation included clinical examination, biological tests and radiological exams. The absence of additional lesions was assessed by standard radiographies associated with a more sensitive technique such as total body MRI, CT-scan and/or PET-CT. Radiotherapy modalities were reviewed. Additional treatment was assessed. Toxicity was evaluated weekly during radiotherapy, then at 6 weeks, 4 months and 1 year using CTCAEv3.0. Local control of the lesion was defined as negativation of PET-CT. Progression was defined as the incidence of a new plasmacytoma or a multiple myeloma. Statistical analysis: Progression-Free Survival (PFS) was defined as the period from the beginning of radiotherapy to the first documentation of progression or death. Patients alive without progression were censored at the date of last known contact. PFS was estimated using the Kaplan Meier method and compared with the log-rank test.
Results
28 patients were analyzed. Median age was 53.5y. Median follow-up was 52.2 months (7-99). 15 patients received the standard treatment, a local 40Gy radiotherapy (group 1); 13 patients (46%) received treatment with IMiDs or PIs, in addition to the 40 Gy local radiotherapy delivered by IMRT (group 2). In group 2, 9 patients (69%) received 4 cycles of lenalidomide+dexamethasone, of whom 2 also received bortezomib (15%); 3 received bortezomib+dex for 4 cycles (23%); and 1 received thalidomide for 12 months (7.5%) There was no significant difference between subgroups by conventional prognostic factors such as age, localization, M-Spike and ECOG. Toxicity was mostly hematological and manageable with standard approaches. 1 patient developed profound venous thrombosis on lenalidomide treatment in spite of aspirin prophylaxis.All patients achieved local control. Overall survival was more than 95% at 4 years. 1 patient died of disease progression (MM) in group 1. In group 1, 5 patients (33%) developed SPB and 5 patients developed multiple myeloma (33%) during follow-up, versus 1 SPB (7.5%) and 1 MM (7.5%) in group 2. PFS rates at 48 months were 50.3% CI95% [29.8 ;84.6] in group 1 and 80.0% CI95% [58.7 ;100] in group 2. PFS was significantly different between groups (p=0.032).
Conclusion
An additional treatment with IMiDs or PI to 40 Gy IMRT is well tolerated and allows prolonged progression-free survival for solitary plasmacytoma of the bone patients. These results need to be confirmed in a larger, standardized clinical trial.
Session topic: E-poster
Keyword(s): Immunomodulatory thalidomide analog, Plasma cells, Radiotherapy, Therapy
Abstract: E1319
Type: Eposter Presentation
Background
SPB is a rare plasma cell dyscrasia characterized by a single bone tumor without evidence of multiple myeloma. Standard treatment is currently local 40Gy radiotherapy. Local control is achieved in more than 90% of patients. However, approximately half of the patients develop further disease progression, be it a new plasmacytoma or multiple myeloma.
Aims
To determine the impact and tolerance of short-term treatment with Immunomodulatory Drugs (ImIDs) or proteasome inhibitors (PI) in association with 40 Gy IMRT on the progression-free survival of SPB patients.
Methods
We retrospectively reviewed the medical and dosimetric records of all patients treated for solitary plasmacytoma of the bone at a single institution between 2004 and 2013. All patients had histologically proven plasmacytoma of the bone, without bone marrow involvement. Initial evaluation included clinical examination, biological tests and radiological exams. The absence of additional lesions was assessed by standard radiographies associated with a more sensitive technique such as total body MRI, CT-scan and/or PET-CT. Radiotherapy modalities were reviewed. Additional treatment was assessed. Toxicity was evaluated weekly during radiotherapy, then at 6 weeks, 4 months and 1 year using CTCAEv3.0. Local control of the lesion was defined as negativation of PET-CT. Progression was defined as the incidence of a new plasmacytoma or a multiple myeloma. Statistical analysis: Progression-Free Survival (PFS) was defined as the period from the beginning of radiotherapy to the first documentation of progression or death. Patients alive without progression were censored at the date of last known contact. PFS was estimated using the Kaplan Meier method and compared with the log-rank test.
Results
28 patients were analyzed. Median age was 53.5y. Median follow-up was 52.2 months (7-99). 15 patients received the standard treatment, a local 40Gy radiotherapy (group 1); 13 patients (46%) received treatment with IMiDs or PIs, in addition to the 40 Gy local radiotherapy delivered by IMRT (group 2). In group 2, 9 patients (69%) received 4 cycles of lenalidomide+dexamethasone, of whom 2 also received bortezomib (15%); 3 received bortezomib+dex for 4 cycles (23%); and 1 received thalidomide for 12 months (7.5%) There was no significant difference between subgroups by conventional prognostic factors such as age, localization, M-Spike and ECOG. Toxicity was mostly hematological and manageable with standard approaches. 1 patient developed profound venous thrombosis on lenalidomide treatment in spite of aspirin prophylaxis.All patients achieved local control. Overall survival was more than 95% at 4 years. 1 patient died of disease progression (MM) in group 1. In group 1, 5 patients (33%) developed SPB and 5 patients developed multiple myeloma (33%) during follow-up, versus 1 SPB (7.5%) and 1 MM (7.5%) in group 2. PFS rates at 48 months were 50.3% CI95% [29.8 ;84.6] in group 1 and 80.0% CI95% [58.7 ;100] in group 2. PFS was significantly different between groups (p=0.032).
Conclusion
An additional treatment with IMiDs or PI to 40 Gy IMRT is well tolerated and allows prolonged progression-free survival for solitary plasmacytoma of the bone patients. These results need to be confirmed in a larger, standardized clinical trial.
Session topic: E-poster
Keyword(s): Immunomodulatory thalidomide analog, Plasma cells, Radiotherapy, Therapy
Type: Eposter Presentation
Background
SPB is a rare plasma cell dyscrasia characterized by a single bone tumor without evidence of multiple myeloma. Standard treatment is currently local 40Gy radiotherapy. Local control is achieved in more than 90% of patients. However, approximately half of the patients develop further disease progression, be it a new plasmacytoma or multiple myeloma.
Aims
To determine the impact and tolerance of short-term treatment with Immunomodulatory Drugs (ImIDs) or proteasome inhibitors (PI) in association with 40 Gy IMRT on the progression-free survival of SPB patients.
Methods
We retrospectively reviewed the medical and dosimetric records of all patients treated for solitary plasmacytoma of the bone at a single institution between 2004 and 2013. All patients had histologically proven plasmacytoma of the bone, without bone marrow involvement. Initial evaluation included clinical examination, biological tests and radiological exams. The absence of additional lesions was assessed by standard radiographies associated with a more sensitive technique such as total body MRI, CT-scan and/or PET-CT. Radiotherapy modalities were reviewed. Additional treatment was assessed. Toxicity was evaluated weekly during radiotherapy, then at 6 weeks, 4 months and 1 year using CTCAEv3.0. Local control of the lesion was defined as negativation of PET-CT. Progression was defined as the incidence of a new plasmacytoma or a multiple myeloma. Statistical analysis: Progression-Free Survival (PFS) was defined as the period from the beginning of radiotherapy to the first documentation of progression or death. Patients alive without progression were censored at the date of last known contact. PFS was estimated using the Kaplan Meier method and compared with the log-rank test.
Results
28 patients were analyzed. Median age was 53.5y. Median follow-up was 52.2 months (7-99). 15 patients received the standard treatment, a local 40Gy radiotherapy (group 1); 13 patients (46%) received treatment with IMiDs or PIs, in addition to the 40 Gy local radiotherapy delivered by IMRT (group 2). In group 2, 9 patients (69%) received 4 cycles of lenalidomide+dexamethasone, of whom 2 also received bortezomib (15%); 3 received bortezomib+dex for 4 cycles (23%); and 1 received thalidomide for 12 months (7.5%) There was no significant difference between subgroups by conventional prognostic factors such as age, localization, M-Spike and ECOG. Toxicity was mostly hematological and manageable with standard approaches. 1 patient developed profound venous thrombosis on lenalidomide treatment in spite of aspirin prophylaxis.All patients achieved local control. Overall survival was more than 95% at 4 years. 1 patient died of disease progression (MM) in group 1. In group 1, 5 patients (33%) developed SPB and 5 patients developed multiple myeloma (33%) during follow-up, versus 1 SPB (7.5%) and 1 MM (7.5%) in group 2. PFS rates at 48 months were 50.3% CI95% [29.8 ;84.6] in group 1 and 80.0% CI95% [58.7 ;100] in group 2. PFS was significantly different between groups (p=0.032).
Conclusion
An additional treatment with IMiDs or PI to 40 Gy IMRT is well tolerated and allows prolonged progression-free survival for solitary plasmacytoma of the bone patients. These results need to be confirmed in a larger, standardized clinical trial.
Session topic: E-poster
Keyword(s): Immunomodulatory thalidomide analog, Plasma cells, Radiotherapy, Therapy
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