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Anaplastic Multiple Myeloma: Case Series and Literature Review
Jian Wu1, Emily Chu1, Cristiana Costa Chase1, Taewoong Choi1, Cristina Gasparetto1, Ken Young2, Yubin Kang1*
1Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
2Division of Hematopathology, Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
Corresponding Author: Yubin Kang ORCID iD
Address: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Received date: 13 December 2021; Accepted date: 08 January 2022; Published date: 15 January 2022
Citation: Wu J, Chu E, Chase CC, Choi T, Gasparetto C, Young K, Kang Y. Anaplastic Multiple Myeloma: Case Series and Literature Review. Asp Biomed Clin Case Rep. 2022 Jan 15;5(1):1-11.
Copyright © 2022 Wu J, Chu E, Chase CC, Choi T, Gasparetto C, Young K, Kang Y. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Anaplastic Multiple Myeloma, Multiple Myeloma, Case Series, Treatment, Prognosis
Abbreviations: AMM: Anaplastic Multiple Myeloma; MM: Multiple Myeloma; PFS: Progression Free Survival; OS: Overall Survival; MGUS: Monoclonal Gammopathy of Undetermined Significance; CKS1B: Cyclin Kinase Subunit 1B; EMP: Extramedullary Plasmacytoma; PBL: Plasmablastic Lymphoma
Background: Anaplastic multiple myeloma (AMM) is a very rare but distinct subtype of multiple myeloma (MM) with an extremely poor prognosis. Due to its rarity, AMM lacks detailed descriptions and clear definitions. Moreover, there is no consensus on the treatment and evidence suggests that AMM responds poorly to several novel therapies. We conducted a literature review and retrospective case series to determine clinical characteristics, pathological features, and outcomes of AMM.
Case Presentation: Published case reports and case series of AMM since 1983 were systematically extracted and reviewed. A total of 52 patients with AMM were reported in the PUBMED since 1983, including 26 males (50%) and 26 females (50%). The age ranged from 29 years old to 85 years old, with a mean age of 57.02 years old. Most of the patients presented with bone pain (23, 44.2%), fatigue (18, 34.6%), plasmacytoma (18, 34.6%) and weight loss (7, 13.5%). The median survival of the patients was 4 months. To investigate the outcomes of patients with AMM in the current era of treatment, a series of 14 patients with AMM diagnosed at our institute between December 2012 and July 2021was retrospectively analyzed. Our retrospective case series consisted of 12 males (85.7%) and 2 females (14.3%), with a mean age of 59 years old. Most of our AMM patients displayed bone lytic lesions as a common manifestation. The common cytogenetic abnormality was 1q amplification. All patients received standard combination chemotherapy consisting of proteasome inhibitors and/or immunomodulatory agents, and half of the patients underwent autologous hematopoietic stem cell transplantation. The median progression-free survival (PFS) and overall survival (OS) for our 14 AMM patients were 0.84 years and 1.52 years, respectively, which was significantly worse than the regular MM patients treated at our institute from 2003-2013 who had a PFS of 2.28 years and OS of 4.92 years.
Conclusions: AMM is a very rare, morphologically distinct variant of MM. It has adverse cytogenetics and an aggressive course. It is often resistant to standard chemotherapy and presents with an extremely low survival rate.