The prognosis after progression to multiple myeloma is also poorer for osseous plasmacytoma than for extra-medullary plasmacytoma as evidenced by multiple retrospective studies. These differences suggest a difference in the biological behavior of the two types of tumor, which is further augmented by immunohistochemical staining and flow cytometry analysis. The persistence of myeloma protein after radiation can serve to identify patients who are at high risk of early progression. 5,7 MRI studies can detect patients with occult myeloma. Due to the difficulty in predicting survival, patients with an apparently solitary plasmacytoma of bone deserve aggressive radiotherapeutic and appropriate orthopedic management.
Radiation therapy is the primary modality of treatment.
The recommended dose of radiation is 50 to 60 Gy in five to seven weeks. 10-12 Surgical intervention may include fixation of pathologic fractures, prophylactic fixation to prevent fracture, and decompression and stabilization of spine lesions. The use of adjuvant chemo-therapy for osseous plasmacytoma may prevent progression to multiple myeloma. 14 Holland et al 15 found that adjuvant cytotoxic therapy delayed the median time of progression from 29 months to 59 months, but this did not affect the overall rate of progression to myeloma or the survival rates after the development of myeloma. Adjuvant chemotherapy may be beneficial in patients with either persistent myeloma protein or nonsecretory disease who are at a high risk for developing multiple myeloma.