Revised diagnostic criteria for plasma cell leukemia: Results of a Mayo Clinic study with comparison of outcomes to multiple myeloma Journal Article


Authors: Ravi, P.; Kumar, S. K.; Roeker, L.; Gonsalves, W.; Buadi, F.; Lacy, M. Q.; Go, R. S.; Dispenzieri, A.; Kapoor, P.; Lust, J. A.; Dingli, D.; Lin, Y.; Russell, S. J.; Leung, N.; Gertz, M. A.; Kyle, R. A.; Bergsagel, P. L.; Rajkumar, S. V.
Article Title: Revised diagnostic criteria for plasma cell leukemia: Results of a Mayo Clinic study with comparison of outcomes to multiple myeloma
Abstract: The current definition of plasma cell leukemia (PCL)- ≥ 20% circulating plasma cells (CPCs) on peripheral smear and plasma cell count ≥ 2 × 109/L-may be too stringent. We reviewed outcomes of 176 multiple myeloma (MM) patients diagnosed between 1971 and 2016, and who had CPCs detectable at diagnosis, to determine whether a lower threshold could be used to diagnose PCL. Median overall survival (mOS) was 1.1 years (95% CI 0.8-1.4) and was similar between patients with < 5% (n = 54, mOS = 1.4 years [0.7-2.0]), 5-19% (n = 63, mOS = 1.1 years [0.7-1.4]), and ≥ 20% CPCs (n = 59, mOS = 1.1 years [0.7-1.5], p = 0.349). As survival was similar between those with 5-19% and ≥ 20% CPCs, we stratified patients by < 5% (mOS = 1.4 years [0.7-2.0]) and ≥ 5% CPCs (mOS = 1.1 years [0.8-1.4], p = 0.154). Outcomes of those with ≥ 5% CPCs were much poorer when compared with a cohort of MM patients diagnosed between 1971 and 2016, who did not have CPCs at diagnosis (n = 9724, mOS = 4.4 yrs [4.3-4.5], p < 0.001); survival was also lower in patients diagnosed after 2001 with ≥ 5% CPCs (n = 62, mOS = 1.4 years [0.8-2.5]) compared with patients with standard risk (n = 1326, mOS = 7.5 years [7.0-8.7]) and high-risk MM (n = 381, mOS = 4.3 years [3.5-4.9], p < 0.001). We therefore propose that the definition of PCL be revised to patients with ≥ 5% CPCs on peripheral blood smear, who otherwise meet diagnostic criteria for MM.
Journal Title: Blood Cancer Journal
Volume: 8
Issue: 12
ISSN: 2044-5385
Publisher: Nature Publishing Group  
Date Published: 2018-11-15
Start Page: 116
Language: English
DOI: 10.1038/s41408-018-0140-1
PUBMED: 30442928
PROVIDER: scopus
PMCID: PMC6238010
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Lindsey Elizabeth Roeker
    13 Roeker