From the Guidelines
The management of plasma cell neoplasm of the jaw should involve a multidisciplinary approach with systemic chemotherapy, radiation therapy, and surgical intervention as needed, prioritizing the prevention of skeletal-related events and maintaining quality of life, as outlined in the NCCN clinical practice guidelines 1. The initial treatment typically involves systemic chemotherapy with regimens such as VRD (bortezomib, lenalidomide, dexamethasone) or CyBorD (cyclophosphamide, bortezomib, dexamethasone) for 3-6 months.
- Radiation therapy at doses of 40-50 Gy is often added for localized disease control.
- Surgical intervention may be necessary for pathological fractures, severe pain, or neurological compromise, ranging from curettage to segmental resection with reconstruction.
- Bisphosphonates like zoledronic acid (4mg IV monthly) or denosumab (120mg subcutaneously monthly) are essential to prevent skeletal-related events, with consideration of the risk of medication-related osteonecrosis of the jaw (MRONJ) as outlined in the MASCC/ISOO/ASCO clinical practice guideline 1. Key aspects of management include:
- Pain management with NSAIDs, opioids as needed, and adjuvant medications like gabapentin for neuropathic pain.
- Regular follow-up with imaging (CT or MRI) every 3-6 months to monitor response.
- Dental evaluation before and during treatment to manage complications like osteonecrosis of the jaw. This comprehensive approach targets both the neoplastic cells and provides symptomatic relief while preserving jaw function and quality of life, with the treatment plan individualized based on the extent of disease, patient's age, comorbidities, and whether the lesion represents a solitary plasmacytoma or is part of systemic multiple myeloma, as recommended by the NCCN guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Plasma Cell Neoplasm (Multiple Myeloma) of the Jaw
The management of plasma cell neoplasm (multiple myeloma) of the jaw involves a combination of treatments, including:
- Radiation therapy: which is the primary treatment modality for solitary plasmacytomas, providing excellent local control and potentially leading to long remission or cure 2
- Systemic therapy: such as lenalidomide-dexamethasone, which can be used in combination with radiation therapy to improve multiple myeloma-free survival and progression-free survival rates 3
- Surgery: may be necessary in some cases, such as for diagnostic purposes or to manage complications 4
- Palliative care: to manage symptoms such as pain and improve quality of life 5, 2
Treatment Options
Treatment options for plasma cell neoplasm (multiple myeloma) of the jaw include:
- Radiation therapy alone: which can provide local control and improve symptoms 2
- Combination therapy: such as lenalidomide-dexamethasone with radiation therapy, which can improve multiple myeloma-free survival and progression-free survival rates 3
- Chemotherapy: such as bortezomib, cyclophosphamide, and dexamethasone, which can be used to treat resistant or recurrent disease 6
Prognosis
The prognosis for plasma cell neoplasm (multiple myeloma) of the jaw is generally poor, with a 5-year overall survival rate of 26.6% 4. However, treatment outcomes can vary depending on the specific type and stage of the disease, as well as the effectiveness of treatment. Early diagnosis and treatment are critical to improving outcomes.
Radiation Therapy
Radiation therapy is an effective treatment for plasma cell neoplasm (multiple myeloma) of the jaw, providing local control and improving symptoms. The use of intensity-modulated radiation therapy (IMRT) can help reduce toxicity and improve treatment outcomes 3. Radiation therapy can be used alone or in combination with systemic therapy, such as lenalidomide-dexamethasone. The role of palliative radiation therapy in multiple myeloma is also important, providing effective pain relief and improving quality of life 5, 2