Devita, Hellman, and Rosenberg's Cancer

LWBK1006-34 LWW-Govindan-Review November 24, 2011 11:25

Chapter 34•Plasma Cell Neoplasms 467

Question 34.10. A 60-year-old female presents with pain in the left arm. X-rays show a

large lytic lesion in the shaft of the left humerus. Biopsy of the lesion

reveals a kappa restricted plasma cell population. The patient has normal

blood counts and renal function. A skeletal survey fails to reveal any

additional lesions. SPEP shows an IgG kappa monoclonal spike measuring

0.4 g/dL. UPEP fails to reveal any monoclonal protein. Bone marrow

biopsy shows 3% nonclonal plasma cells. All of the following statements

are true, EXCEPT:

A. Age has no impact on overall survival (OS).

B. An MRI of the spine and pelvis is indicated.

C. African Americans have a poorer survival compared with Caucasian

population.

D. Patients with solitary bone plasmacytomas have a worse outcome

compared to patients with solitary extramedullary plasmacytomas.

Question 34.11. A 47-year-old male presents with fatigue. The patient is found to be ane-

mic with an Hb of 6.7 g/dL. He has a WBC of 2000 with 21% circulating

plasma cells and a platelet count of 79,000. He has a serum creatinine of

1.8 mg/dL with a normal serum calcium. SPEP and UPEP fail to reveal a

monoclonal protein. Skeletal survey shows no lytic lesions. Bone marrow

biopsy shows a lambda restricted clonal plasma cell population consti-

tuting 40% of marrow cellularity. Which of the following statements is

correct?

A. For a diagnosis of plasma cell leukemia, the absolute WBC has to be

>10,000.

B. As is the case with multiple myeloma, OS of patients with plasma cell

leukemia has improved significantly.

C. The incidence of plasma cell leukemia is equal in males and females.

D. Autologous stem cell transplantation is of no utility in this situation.