SOHO Italy 2025 | The current management of extramedullary disease and plasma cell leukemia

Recently, it was published the new recommendation from the EMN for the treatment of the plasma cell leukemia. Of course, in transplant-eligible patients, we need a quadruplet, dara-VTd or dara-VRd outside Italy we can use also the thalidomide. And the transplant plus radiation and maintenance. What’s the problem? 

Then we can use four cycles for the patients that have after the induction a CR or MRD response, or six cycles for the patients that don’t achieve this response, or the double transplant, autotransplant and allotransplant for the patients that they are refractory or with not optimal response to the therapy. 

For the non-transplant eligible patients in the plasma cell leukemia, we need a quadruplet, Dara-VMP or Dara-VRd. In the frail patient, exclusively doublets is the therapy. We can use a chemotherapy and allotransplant for the relapsed and refractory patients if they achieved the response. And a new treatment could be the venetoclax. 

For the extramedullary disease, we need a chemotherapy. Because the real extramedullary disease is an emergency, for example, the skin, the central nervous system, for example, or the lung, we need a chemotherapy plus the novel agent. VRd, Daratumumab-VRd, PACE, for example. The transplant, maybe the double transplant, is impossible. Not transplant-eligible, also the quadruplets. This is very important. For the relapse of treatment, we have the possibility to use the carfilzomib for example, and the other treatment, but this is the future for the treatment of this patient.

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