Plasmacitomul solitar. Tabloul clinic şi tratamentul

Abstract

Data abouth 8 patients (4 males and 4 females) with solitary plasmacytoma are described. The median age at diagnosis was 51,3 years (range 20-73 years). Three patients had o solitary plasmacytoma of the bone, 5 had solitary extramedullary plasmacytoma. Of 3 cases with solitary plasmacytoma of the bone spinal column (Th 5-6) in one patient was affected, in other tibia with patological fracture, in the third left scapula. Of 5 cases with solitary extramedullary plasmacytoma in three patients tumoral focus appeared in nasal submucosis, in one patient larynx was affected, in one female cervix was affected. The clinical manifestations were determinated by localization of primary tumor. The signs of general intoxication were absent. The treatment included 3 cycles of chemotherapy COP or CHOP, locoregional radiotherapy (40-44 Gy) folowed by 3 cycles of the same chemotherapy. Of 8 patients 7 finished the treatment with achivement of complete remission. In 6 patients the remission has been lasting one year, one year and 3 months, 5, 6, 7 and 8 years respectively. One patient with solitary plasmacytoma of the bone after achivement of complete remission has disappeared. The authors consider that combined chemoradiotherapy of solitary plasmacytoma ensured excellent rates results.

Sunt descrise datele despre 8 pacienţi (4 bărbaţi şi 4 femei) cu plasmacitom solitar. Vârsta medie 51,3 de ani (20-73 de ani). Trei bolnavi au fost cu plasmacitom solitar al oaselor, 5 – cu plasmacitom solitar extramedular. Din cele 3 cazuri cu plasmacitom solitar al oaselor la un bolnav au fost afectate vertebrele Th 5-6, la altul tibia cu fractură patologică, la al treilea omoplatul de stânga. Din 5 pacienţi cu plasmacitom solitar extramedular focarul tumoral în 3 cazuri a apărut în submucoasa nasală, la un bolnav a fost afectat laringele. La o pacientă a fost afectat colul uterin. Manifestările clinice au fost determinate de localizarea primară a tumorii. Semne de intoxicare generală au lipsit. Tratamentul a inclus 3 cicluri de polichimioterapie COP sau CHOP, radioterapie locoregională în doza sumară 40-44 Gy, după care s-au efectuat încă 3 cicluri de polichimioterapie. Din 8 pacienţi au finalizat tratamentul 7 cu obţinerea remisiunii complete, care la 6 pacienţi se prelungeşte respectiv 1 an, 1 an şi 3 luni, 5, 6, 7 şi 8 ani. O bolnavă după obţinerea remisiunii complete ulterior nu s-a prezentat la control. Autorii consideră că tratamentul combinat chimioradioterapeutic al plasmacitomului solitar este optimal.