Pleuro-Pulmonary Extramedullary Plasmacytomas in Multiple Myeloma: A 15-Year Experience from a Tertiary Center
by
, , , and
Sorina Badelita
1,
Sinziana Barbu
1,2,*,
Camelia Dobrea
1,2,
Cerasela Jardan
1,2,
Monica Popescu
1,
Codruta Delia Popa
1,2,
Claudia Toma
3,
Larisa Zidaru
1,
Mihai Emanuel Himcinschi
2,4,
Horia Mihail Sandu
1,
Didona Vasilache
1,
Adelina Vlad
5 and
Daniel Coriu
1,2 1
Clinical Department I, Hematology, Fundeni Clinical Institute, 022328 Bucharest, Romania
2
Hematology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
3
Clinical Pneumology Department, “Dr. Marius Nasta” Hospital, 050159 Bucharest, Romania
4
Biochemistry Department, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
5
Physiology Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
*
Author to whom correspondence should be addressed.
Cancers 2026, 18(1), 19; https://doi.org/10.3390/cancers18010019
Submission received: 10 November 2025
/
Revised: 13 December 2025
/
Accepted: 18 December 2025
/
Published: 20 December 2025
(This article belongs to the Special Issue Diagnosis of Hematologic Malignancies: 2nd Edition)
Simple Summary
Patients with multiple myeloma can develop lesions outside the bone marrow, in the lungs and pleura, a rare but very aggressive form that has been little described so far. We retrospectively analyzed, at a single center, all cases diagnosed between 2010 and 2025 and identified 34 patients with pleuropulmonary involvement. We described how the disease occurs (at onset or relapse), how it manifests (pulmonary infiltrates, pleural involvement, pleural effusion), the diagnostic methods used, and survival. The results show an unfavorable evolution, with a median survival of 16 months and only a quarter of patients alive at 2 years. This study provides one of the largest series published on this topic and emphasizes the need for personalized treatments and modern strategies (e.g., targeted antibodies or modified T cells), providing the basis for future recommendations and clinical trials.
Abstract
Background/Objectives: Extramedullary involvement in multiple myeloma represents an aggressive disease phenotype, associated with reduced survival and an unfavorable prognosis. Thoracic manifestations are rare and remain poorly characterized in the literature. Methods: We conducted a retrospective, single-center study at the Fundeni Clinical Institute, including patients diagnosed with multiple myeloma between February 2010 and February 2025. The study cohort consisted of 34 patients with infiltration of the pulmonary parenchyma, pleura, or the presence of myelomatous pleural effusion. Diagnosis was confirmed using a combination of imaging modalities (computed tomography or magnetic resonance imaging), cytological examination, immunophenotyping, and histopathological confirmation whenever feasible. Results: Out of a total of 2012 patients with multiple myeloma, the incidence of pleuro-pulmonary extramedullary involvement was 1.6%. The median age at diagnosis was 58 years. Pleuro-pulmonary disease was present at initial diagnosis in 26.5% of cases, while 73.5% developed it at relapse. The most common presentation involved combined pleural involvement and myelomatous effusion (70.6%). Adverse prognostic markers included elevated β2-microglobulin levels (in over 80% of cases) and increased lactate dehydrogenase (LDH) in approximately 50%. Cytogenetic abnormalities such as del(17p), t(4;14), t(14;16), t(11;14), and 1q gain were identified. The median overall survival (OS) from the diagnosis of pleuro-pulmonary extramedullary disease was 16 months, with a 2-year survival rate of 25%. No patient survived beyond 5 years. The median progression-free survival (PFS) was 9 months. Conclusions: Our findings confirm the aggressive clinical course and poor prognosis of these disease manifestations, mainly when they occur at relapse. In the absence of standardized treatment guidelines, individualizing therapy and accessing novel strategies may be essential for improving patient survival.
