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Case History


Image not available. A 46-year-old man presents with a pathological fracture of his left clavicle. He is diagnosed as suffering from plasma cell myeloma (PCM) based on a skeletal survey indicating multiple lytic lesions, serum electrophoresis revealing an immunoglobulin G (IgG) κ level of 54 g/l and a bone marrow infiltrate of 24% malignant plasma cells on diagnostic biopsy. He has one human leukocyte antigen (HLA)-identical sibling.

What is the optimal management of the man's disease?

What is the role of allogeneic stem cell transplantation in his management strategy?

Where in his management should novel therapy be introduced?




Image not available. Prior to the introduction of alkylating agents, the median survival of patients with PCM was less than 1 year.1 Approximately 60% of patients will respond to conventional chemotherapy, though approximately 25% of patients will be alive at 5 years and less than 10% will be alive at 10 years. The aim of therapy in patients with PCM is to control the disease process, to maximize quality of life and to prolong survival. Response criteria were first developed by the Committee of the Chronic Leukemia and Myeloma Task Force of the US National Cancer Institute in 1968, and were subsequently reviewed in 1973. In 1998, the Myeloma Subcommittee of the European Blood and Marrow Transplantation (EBMT) Chronic Leukaemia Working Party, in collaboration with the Myeloma Working Committee of the International Bone Marrow Transplant Registry, set out what have been universally adopted response criteria.2 The main tenets are illustrated in Table 34.1. The published documents provide criteria for complete response (CR), partial response (PR), minimal response, stable disease, progressive disease, plateau response and relapse.

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Table 34.1EBMT clinical response criteria.2

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