Author Affiliations

  1. Mary B. Drake1,
  2. Simona Iacobelli2,
  3. Anja van Biezen2,
  4. Curly Morris1,
  5. Jane F. Apperley3,
  6. Dietger Niederwieser4,
  7. Bo Björkstrand5 and
  8. Gösta Gahrton5
  9. on behalf of the European Group for Blood and Marrow Transplantation and the European Leukemia Net
  1. 1 Belfast City Hospital, Northern Ireland, UK
  2. 2 Leiden University Medical Centre, Leiden, The Netherlands
  3. 3 Hammersmith Hospital, London, UK
  4. 4 University of Leipzig, Germany
  5. 5 Karolinska Institute, Huddinge, Stockholm, Sweden
  1. Correspondence: Dr. Mary Drake, Lisburn Road, Belfast, Northern Ireland, UK BT9 7 AB. E-mail: mary.drake{at}belfast-trust.hscni.net
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Abstract

Background Primary plasma cell leukemia is a rare disorder accounting for less than 5% of malignant plasma cell diseases. It has a poor prognosis compared to multiple myeloma, with a median survival of 8–12 months. The results of conventional therapy are disappointing though autologous stem cell transplantation may improve survival.

Design and Methods A retrospective analysis was undertaken of the European Group for Blood and Marrow Transplantation experience of 272 patients with plasma cell leukemia and 20844 with multiple myeloma undergoing first autologous transplantation between 1980 and 2006. All patients were reported to the European Group for Blood and Marrow Transplantation registry using MED-A (limited data) or MED-B (extensive data) forms. All patients were included regardless of availability of complete data.

Results There was no difference in type of graft or use of total body irradiation between patients with plasma cell leukemia and multiple myeloma, but the group with plasma cell leukemia was transplanted earlier after diagnosis (6.0 versus 7.7 months, P=0.000). Patients with plasma cell leukemia were more likely to enter complete remission after transplantation but their overall survival (25.7 months, 95% confidence interval 19.5–31.9 months) was inferior to that of patients with multiple myeloma (62.3 months, 95% confidence interval 60.4–64.3 months) (P=0.000), due to the short duration of their post-transplant response and increased non-relapse-related mortality.

Conclusions This largest study ever reported on plasma cell leukemia suggests that autologous transplantation can improve outcome, although results are markedly inferior to those achieved in patients with multiple myeloma, highlighting the need for novel approaches to this aggressive disorder.

  • Received June 29, 2009.
  • Revision received September 21, 2009.
  • Accepted October 9, 2009.
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