Plasma Cell Leukemia

What is plasma cell leukemia?

Plasma cell leukemia is an aggressive type of multiple myeloma. It happens when abnormal plasma cells circulate in your bloodstream. This differs from typical multiple myeloma, in which the abnormal plasma cells stay in your bone marrow.

Plasma cell leukemia is most common in people assigned male at birth (AMAB) between the ages of 55 and 65. It’s also more common among people who are Black. But overall, the condition is rare. In fact, it’s the rarest form of multiple myeloma, making up about 2% to 3% of all plasma cell cancers.

Treatment can slow the cancer, relieve symptoms and prolong life, but typically doesn’t cure it. New treatments can prolong the lives of people with plasma cell leukemia, but there’s still much work to do.

Types of plasma cell leukemia

There are two types of plasma cell leukemia:

1. Primary: Plasma cell leukemia without a history of multiple myeloma. This means that abnormal cells are already circulating in your bloodstream at the time of diagnosis. Primary PCL affects about 1 person out of every 1 million people in the general population and makes up about 60% of all plasma cell leukemia cases.
2. Secondary: Plasma cell leukemia with a history of multiple myeloma. This is when you already have multiple myeloma, but it gets worse. According to research, 0.5% to 4% of multiple myeloma cases turn into secondary PCL. Secondary PCL leukemia affects up to 4 in 100 people with multiple myeloma and makes up about 40% of all plasma cell leukemia cases.

What are the symptoms of plasma cell leukemia?

Plasma cell leukemia symptoms vary for each person. But they may include:

• Anemia.
• Bleeding easily.
• Bone pain.
• Bone fracture
• Fatigue.
• High calcium levels in your blood (hypercalcemia).
• Infections that linger or come back frequently.
• Kidney damage.

What causes plasma cell leukemia?

Acquired genetic changes during plasma cell development cause plasma cell leukemia. But researchers aren’t sure why these changes take place to begin with.

How is plasma cell leukemia diagnosed?

A healthcare provider will need to measure the number of abnormal plasma cells in your blood. To do this, they’ll need to do a blood test. If you have plasma cell leukemia, abnormal cells will make up over 5% of your total white blood cells.

Your provider will also do a bone marrow biopsy to measure the number of abnormal plasma cells in your bone marrow. They’ll also use imaging tests like CT scans (computed tomography scan) or MRI (magnetic resonance imaging) to check for bone damage that can result from these cells.

How is plasma cell leukemia treated?

Healthcare providers treat plasma cell leukemia on a case-by-case basis. They might recommend one type of treatment or a combination.

Plasma cell leukemia treatments include the same ones that are used in multiple myeloma:

• Autologous stem cell transplant. Providers usually do this type of stem cell transplant after chemotherapy if you’re eligible.
• Chemotherapy. This may include chemotherapy drugs like doxorubicin (Adriamycin^®), cisplatin and cyclophosphamide (Cytoxan_^®).
• Immunotherapy. This treatment includes monoclonal antibodies like daratumumab (Darzalex®), bispecific antibodies like teclistamab (Tecvayli®) and chimeric antigen receptor (CAR) T-cell therapy.
• Targeted therapy. This treatment includes proteasome inhibitors like bortezomib (Velcade^®), carfilzomib (Kyprolis^®) and ixazomib (Ninlaro^®) as well as immunomodulators like lenalidomide (Revlimid®) and pomalidomide (Pomalyst^®).

Your healthcare provider may also recommend palliative care to ease your symptoms and support you through your journey.

Can plasma cell leukemia be prevented?

You can’t prevent plasma cell leukemia because you can’t control the genetic changes that cause it. This condition is difficult to study because it’s so rare. But researchers continue to look for ways to detect it earlier.

What is the outlook for plasma cell leukemia?

Plasma cell leukemia is an aggressive disease and is often fatal. Less than 10% of people with this type of cancer live longer than five years after their diagnoss. People with primary plasma cell leukemia usually live longer compared to those with secondary plasma cell leukemia.

Life expectancy varies depending on the severity of disease, what type of treatment you receive and how your body responds to that treatment.

Those who qualify for a stem cell transplant may live three to four years on average. But some people may live longer. One research study reported a case of plasma cell leukemia that had been in remission for nine years before relapsing.

People with this condition are living slightly longer today than they were a couple of decades ago. While it’s progress, it’s only a small improvement. But researchers continue to follow that thread.

How do I take care of myself?

Having plasma cell leukemia can make your future seem uncertain. And you’ll likely experience a flood of different emotions like fear, anger, sadness, frustration or guilt. Remember there’s no right or wrong way to feel. It’s important to process your feelings. Talk to someone you trust or ask your healthcare provider for resources. They can help you maintain your quality of life after diagnosis and during treatment.

When should I see my healthcare provider?

You’ll stay in close contact with your healthcare provider throughout your treatment. But you should let them know if you experience new or worsening symptoms.

What questions should I ask my doctor?

If you have plasma cell leukemia, you’ll probably have lots of questions for your healthcare provider. Here are some things you might want to ask:

• How advanced is the cancer?
• What are my treatment options?
• Am I eligible for a stem cell transplant?
• How long can I live with treatment?
• What resources should I take advantage of?