International Journal of Hematology

DOI: 10.1007/s12185-009-0288-3 Pages: 259-268

Plasma cell leukemia: a highly aggressive monoclonal gammopathy with a very poor prognosis

1. Mayo Clinic Scottsdale

2. INCMNSZ

Correspondence to:
Victor H. Jimenez-Zepeda
Tel: +1-480-3016576
Fax: +1-480-3018387
Email: jimenezzepeda.victor@mayo.edu

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Abstract

Plasma cell leukemia (PCL) is an aggressive variant of multiple myeloma and is characterized by the presence of >20% and/or an absolute number of greater 2 × 10(9)/L plasma cells circulating in the peripheral blood. PCL represents approximately 2–4% of all MM diagnosis and exists in two forms: primary PCL (PPCL, 60% of cases) presents de novo, whereas secondary PCL (SPCL, accounts for the remaining 40%) consists of a leukemic transformation in patients with a previously diagnosed MM. Because the mechanisms contributing to the pathogenesis of PCL are not fully understood, immunophenotyping, genetic evaluation (conventional karyotype, FISH, GEP and array-CGH), and immunohistochemistry are really important tools to investigate why plasma cells escape from bone marrow and become highly aggressive. Since treatment with standard agents and steroids is poorly effective, a combination of new drugs as part of the induction regimens and bone marrow transplant (autologous and allogeneic approaches) could nearly overcome the poor prognosis exhibited by PCL patients.

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