Plasma Cell Neoplasia in Dogs: Plasmacytoma, Multiple Myeloma & Treatment
When we talk about plasma cell neoplasia, it’s important to remember that we’re not really talking about one single disease.
Plasma cell tumours arise from terminally differentiated B-cells, the cells responsible for producing antibodies. But clinically, plasma cell neoplasia exists on a spectrum, ranging from solitary, localised tumours through to disseminated
systemic disease, or multiple myeloma.
And, as you’d expect, where a patient sits on that spectrum can make a significant difference to how we approach the case.
Localised plasma cell tumours
At one end of the spectrum, we have extramedullary plasmacytomas.
These can occur in a number of locations, including the skin, rectum, oral cavity and mucous membranes, colon and other soft tissues. Depending on the individual tumour and its location, treatment options can include surgery or radiation therapy.
A localised plasmacytoma is therefore a very different clinical proposition from a dog presenting with systemic plasma cell disease.
And that distinction matters.
When plasma cell disease becomes systemic
At the other end of the spectrum is multiple myeloma.
When disease is systemic, chemotherapy is typically required. Rather than treating a single localised lesion, our aims are to control the disease, improve quality of life and manage the clinical signs associated with it.
This is where these patients can become considerably more complex.
How might a dog with multiple myeloma present?
Many dogs with systemic disease are clinically unwell by the time we see them.
Findings can include:
Hypercalcaemia
Hyperviscosity syndrome
Anaemia
Other cytopenias
Of course, not every patient is going to walk through the door with a neat collection of textbook signs. As with so many oncology cases, it’s about looking at the whole clinical picture and working out what the individual findings are telling us.
Don't forget the neurological patient
One presentation that's particularly important not to overlook is neurological disease.
Some patients can develop neurological deficits associated with osteolytic vertebral lesions, so spinal involvement should be considered when a dog with suspected plasma cell neoplasia is showing neurological abnormalities.
This is a good example of why these cases sometimes require us to think beyond the most obvious presentation.
So, what do we do next?
That really depends on the patient in front of us.
Is this a solitary lesion that can be managed locally? Are there findings that make us concerned about systemic disease? Do we need further investigation or staging? And, ultimately, will those investigations change what we recommend for this particular patient?
This is where I find a case-by-case approach particularly valuable.
The aim isn't simply to arrive at a diagnosis. It's to understand the extent of the disease and use that information to develop a treatment plan that makes sense for the individual dog and their family.
Need support with a suspected plasma cell neoplasia case?
If the diagnostic picture isn't straightforward, or you're unsure about staging or the most appropriate treatment approach, OncoTails can provide specialist oncology input while your patient remains under the care of your practice.
Support is available with diagnosis, staging, treatment planning, chemotherapy guidance and ongoing case management.
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