KCMC-FCCT Tumor Board April 2023

By Randy Hurley MD, cTropMed
HealthPartners and Regions Hospital Cancer Care Centers
Global Health Faculty, University of Minnesota
April 14, 2023


February. A recurring theme continues to be the need for radiation therapy facilities at KCMC to provide adequate cancer care.  A case of a 45-year-old man with a plasmacytoma of bone was discussed. The man had presented with paraplegia from a thoracic vertebral spinal mass and required urgent decompressive laminectomy with hardware stabilization.  The pathology disclosed malignant plasma cells consistent with a plasmacytoma.  Arrangements for further evaluation to rule out multiple plasmacytomas of bone and multiple myeloma were requested. The patient had been referred to Ocean Road Cancer Center (ORCI)  in Dar Es Salaam for post operative radiation therapy. This would be standard treatment  in the United States; however, there was hesitancy at ORCI due to the presence of stabilizing hardware in the spine. This would not be a contraindication to radiation in the USA.  Plasmacytoma of bone is part of the spectrum of malignant plasma cell disorders encompassing monoclonal gammopathy of unknown significance all the way to multiple myeloma and plasma cell leukemia.  The incidence of multiple myeloma is rising in the United States and is much more common in African Americans. The etiology is likely multifactorial; however, exposure to pesticides and even Agent Orange has been implicated.  There are at least seven different categories of drugs used to treat plasma cell disorders in the USA and it is now one of the most common indications for stem cell transplant in adults.

Little is known about the incidence of plasma cell disorders in Tanzania. Fortunately, however, KCMC has published data on all hematologic malignancies at KCMC’s cancer care center for the 3 year period from the opening of the cancer care center in December 2016 thru May of 2019: Leak AL et.al, PLOSone, 2020; 1-12  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202623/). Multiple myeloma accounted for forty three of the 209 cases of hematologic malignancy in that time period, second only to non-Hodgkin’s lymphoma.  The median age at diagnosis was 58 years and the majority presented at advanced stage.