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Volume 1
Journal of Blood Disorders and Treatment
World Hematology 2018
October 22-23, 2018
October 22-23, 2018 Warsaw, Poland
10
th
World
Hematology and Oncology Congress
Management of orbital plasmacytoma with concurrent plasma cell leukemia: A case report
Rmin Sheila Miranda
Philippine General Hospital, Philippines
S
olitary plasmacytoma of the orbit is very rare, occurring in <1% of plasma cell neoplasm. We present a 49-year-old female with
2-months history of hip pain, associated with visual changes, headache, diplopia and minimal proptosis. Work up revealed anemia,
hypercalcemia, azotemia and lytic lesions on skeletal X-ray. Bone marrow aspiration and biopsy was done which confirmed presence
of plasma cell neoplasm. Improvement of symptoms was noted within 21 days of chemotherapy with Bortezumib, Melphalan and
Dexamethasone. Bortezomib used was not according to the recommended dose (1.3 mg/m
2
); instead, we utilized the dose available
at that time, due to financial constraints. Despite the discrepancy in the dosing of Bortezumib, her symptoms improved as confirmed
by cranial MRI, showing decrease orbital mass size. Other laboratory parameters also showed improvement. Patient was discharged
stable and advised regular out-patient follow-up for chemotherapy and radiation therapy. Plasma cell neoplasms are a group of
disorders associated with proliferation of immunoglobulin-secreting cells derived from B-cells. Involvement of the orbital in plasma
cell leukemia (PCL) is very rare and serious condition. In our literature review, most ocular manifestations present in plasma cell
neoplasmoccur in concurrencewithmultiplemyeloma. Therewere very rare reports of orbital plasmacytoma occurring simultaneously
with PCL. Diagnosis of PCL needs to be made in a timely manner and immediate therapy should be initiated. Strategies to improve
long-term survival include incorporation of high-dose therapy with autologous Stem Cell Transplant (SCT). In patients who are not
candidates for SCT, a Bortezomib-based induction regimen appears to be the best choice. Our case, with its dramatic presentation
and quick resolution of the symptoms after initiation of induction chemotherapy with Bortezomib, Dexamethasone and Melphalan,
showcases the importance of prompt recognition of disease and immediate referral to a hematologist for evaluation and management,
so as to institute chemotherapy as soon as possible.
rsjmmd@gmail.comJ Blood Disord Treat 2018, Volume 1