How is solitary bone plasmacytoma (SBP) treated?

Updated: Dec 31, 2019
  • Author: Suzanne R Fanning, DO; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Solitary bone plasmacytoma

Local radiotherapy is the treatment of choice for solitary bone plasmacytome (SBP). [10, 7, 13, 19] Treatment fields should be designed to encompass all disease observed on MRI and should include a margin of healthy tissue (at least 2 cm). For spinal lesions, the margins should include at least 1 uninvolved vertebra.

Local control is achieved in 88-100% of patients. Virtually all patients have major symptom relief, [13] and the local tumor recurrence rate is approximately 10%.

Most centers use approximately 40 Gy for spinal lesions and 45 Gy for other bone lesions. For lesions larger than 5 cm, 50 Gy should be considered.

No dose-response relationship between radiation dose and disappearance of monoclonal protein was noted in a series of patients with soSBP, as reported by Liebross et al. [19]  Monoclonal protein is markedly reduced after radiotherapy in the majority of patients, but protein disappearance is observed in only 20-50% of patients. [14]

Surgery is contraindicated in the absence of structural instability or neurologic compromise. [45]

Chemotherapy may be considered for patients not responding to radiation therapy. Regimens useful in multiple myeloma can be considered. [45]  No role exists for adjuvant chemotherapy in SBP.


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