Hello,
As I have mentioned previously here in the forum, Dad was diagnosed with multiple myeloma last year and did an autologous bone marrow transplant 5 months ago.
During the 3 months post transplantation he was admitted twice to the hospital with fever and they couldn't find a cause and since it responded to paracetamol (Tylenol, acetaminophen), they thought it was a kind of reaction post transplantation.
Then when he was regaining his health he started maintenance lenalidomide (Revlimid) with half the dose (capsule every other day), but he still couldn't tolerate the side effects and developed right lower limb deep vein thrombosis (DVT).
We stopped the lenalidomide and the doctor shifted him back to Velcade. We waited till the DVT started to recanalize but before we started the Velcade he developed severe back pain and constipation that wasn't responding to the regular analgesics.
MRI of the lumbosacral spine and sacroiliac joint show a soft tissue starting D10 up to L4-5 level suggestive of either Pott's disease (tuberculosis in the spine), which is a suggestion based on MRI signal and distribution of lesion, or of course myelomatous infilteration. As well as 2 sacroiliac enhanced lesion diagnoses as multiple myeloma recurrence due to the history.
Right now I don't know how to proceed. If it is multiple myeloma instead of Pott's disease, how could it recur so quickly, keeping in mind that 3 months post transplant his immunoglobulin levels were normal?
Thank you so much.
Forums
5 posts
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salma - Name: salma
- Who do you know with myeloma?: father
- When were you/they diagnosed?: 2015
- Age at diagnosis: 63
Re: Spinal plasmacytoma 5 months post transplant?
Hi Salma,
Sorry to hear about your dad's situation. You may want to read this thread and the associated links to better understand how one can develop plasmacytomas even when one's serum markers look normal:
"M-spike is zero, but symptoms are still there" (started June 30, 2016)
How are the doctors planning on figuring out if your dad has Pott's disease or new multiple myeloma activity? I would think that a PET/CT or a biopsy might shed some more light on the situation, but I've never heard of Pott's disease until now and I don' t know if Potts appears differently in a PET/CT than would a myeloma-related plasmacytoma.
Sorry to hear about your dad's situation. You may want to read this thread and the associated links to better understand how one can develop plasmacytomas even when one's serum markers look normal:
"M-spike is zero, but symptoms are still there" (started June 30, 2016)
How are the doctors planning on figuring out if your dad has Pott's disease or new multiple myeloma activity? I would think that a PET/CT or a biopsy might shed some more light on the situation, but I've never heard of Pott's disease until now and I don' t know if Potts appears differently in a PET/CT than would a myeloma-related plasmacytoma.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Spinal plasmacytoma 5 months post transplant?
Thank you, Multibilly, for your reply.
Well, he's scheduled for a biopsy next week after adjusting his INR level (he is on warfarin for the DVT).
I know that it is possible to have plasmacytoma with normal labs.
But dad has a soft tissue paraspinal; there are concerns it might be a psoas abscess or infiltrating myeloma or extramedullary myeloma.
My question is: is it possible to have extramedullary myeloma after bone marrow transplant even if he didn't have it before?
I know it's rare, so is it possible to recur and in such a fashion?
Thanks.
Well, he's scheduled for a biopsy next week after adjusting his INR level (he is on warfarin for the DVT).
I know that it is possible to have plasmacytoma with normal labs.
But dad has a soft tissue paraspinal; there are concerns it might be a psoas abscess or infiltrating myeloma or extramedullary myeloma.
My question is: is it possible to have extramedullary myeloma after bone marrow transplant even if he didn't have it before?
I know it's rare, so is it possible to recur and in such a fashion?
Thanks.
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salma - Name: salma
- Who do you know with myeloma?: father
- When were you/they diagnosed?: 2015
- Age at diagnosis: 63
Re: Spinal plasmacytoma 5 months post transplant?
Hi Salma,
You may want to read this article. There is definitely a population of myeloma patients that have developed extramedullary disease after initial diagnosis, in both post-transplant and post-induction/non-transplant settings.
Varettoni, M, et al, "Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients," Annals of Oncology, July 2009 (full text of article)
Abstract:
Background: There are few data on the incidence and prognosis of extramedullary multiple myeloma. There are concerns about a possible increase of extramedullary relapses with the expanding use of high-dose therapy (HDT) and biological agents.
Patients and methods: The incidence of extramedullary disease, its relationship with prior exposure to HDT or novel agents, and its prognostic impact were analyzed in 1003 multiple myeloma patients. Based on the different therapies available, three periods were considered: 1971–1993, conventional-dose chemotherapy; 1994–1999, HDT for younger patients; and 2000–2007, introduction of novel agents.
Results: Overall, 13% of patients had extramedullary disease, 7% at diagnosis and 6% later. In the 2000–2007 period, there was a significant increase of extramedullary involvement, at diagnosis (P = 0.02) and during follow-up (P = 0.03). The risk of extramedullary spread was not significantly increased after HDT [hazard ratio (HR 0.6)], bortezomib (HR 1.62), or thalidomide / lenalidomide (HR 1.07). Extramedullary disease was associated with shorter overall (HR 3.26, P < 0.0001) and progression-free (HR 1.46, P = 0.04) survival.
Conclusions: The incidence of extramedullary disease has increased, probably due to the availability of more sensitive imaging techniques and the prolongation of patients’ survival. HDT or novel agents seem not to increase the risk of extramedullary disease. Extramedullary involvement confers a poor prognosis.
You may want to read this article. There is definitely a population of myeloma patients that have developed extramedullary disease after initial diagnosis, in both post-transplant and post-induction/non-transplant settings.
Varettoni, M, et al, "Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients," Annals of Oncology, July 2009 (full text of article)
Abstract:
Background: There are few data on the incidence and prognosis of extramedullary multiple myeloma. There are concerns about a possible increase of extramedullary relapses with the expanding use of high-dose therapy (HDT) and biological agents.
Patients and methods: The incidence of extramedullary disease, its relationship with prior exposure to HDT or novel agents, and its prognostic impact were analyzed in 1003 multiple myeloma patients. Based on the different therapies available, three periods were considered: 1971–1993, conventional-dose chemotherapy; 1994–1999, HDT for younger patients; and 2000–2007, introduction of novel agents.
Results: Overall, 13% of patients had extramedullary disease, 7% at diagnosis and 6% later. In the 2000–2007 period, there was a significant increase of extramedullary involvement, at diagnosis (P = 0.02) and during follow-up (P = 0.03). The risk of extramedullary spread was not significantly increased after HDT [hazard ratio (HR 0.6)], bortezomib (HR 1.62), or thalidomide / lenalidomide (HR 1.07). Extramedullary disease was associated with shorter overall (HR 3.26, P < 0.0001) and progression-free (HR 1.46, P = 0.04) survival.
Conclusions: The incidence of extramedullary disease has increased, probably due to the availability of more sensitive imaging techniques and the prolongation of patients’ survival. HDT or novel agents seem not to increase the risk of extramedullary disease. Extramedullary involvement confers a poor prognosis.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Spinal plasmacytoma 5 months post transplant?
Well thank you, that is really helpful.
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salma - Name: salma
- Who do you know with myeloma?: father
- When were you/they diagnosed?: 2015
- Age at diagnosis: 63
5 posts
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