Natural History

Overt multiple myeloma develops in at least 50% of patients with solitary plasmacytoma of bone.2'8 915 In our report of 46 patients, 77% of those who progressed did so within 4 years.2 Dimopoulos et al.16 found that two-thirds of patients who progressed did so within 3 years.

The patterns of failure in our series included development of multiple myeloma in 54%, failure local recurrence in 11%, and development of new solitary bone lesions without evidence of myeloma in 2%. Four of the five local failures in our series occurred in the spine, and all the patients had received less than 45 Gy to the initial lesion.

The overall survival rate in a series of 46 patients was 74% at 5 years and 45% at 10 years. The 5- and 10-year disease-free survival rates were 43% and 25%, respectively. In a series of 12 patients with solitary plasmacy-toma of the vertebral column, multiple myeloma developed in 50%.17 Fifty-eight percent patients were alive at 5 years and 25% at 10 years. An additional 72 patients with solitary plasmacytoma of the spine were identified in the English literature. The mean disease-free duration of survival for the 84 patients was 76 months. The average overall duration of survival was 92 months. The 5-year disease-free survival rate was 60%, and the 10-year disease-free survival rate was 16%.17

In one series, conversion to myeloma occurred in 9 of 11 patients (82%) who had lesions 5 cm or larger, whereas only 5 to 18 patients (28%) who remained stable had lesions that were 5 cm or larger (7).

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