Article Text

Download PDFPDF
Case report
Rare case of non-producer variant of plasma cell dyscrasias with circulating plasma cells
  1. Sukesh Manthri1,
  2. Rabia Zafar2,
  3. Robert Frank Cornell3 and
  4. Kanishka Chakraborty1
  1. 1Division of Hematology/Oncology, Department of Internal Medicine, East Tennessee State University, Johnson City, Tennessee, USA
  2. 2Pathology, East Tennessee State University, Johnson City, Tennessee, USA
  3. 3Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
  1. Correspondence to Dr Kanishka Chakraborty; chakrabk{at}


Non-producing variant of plasma cell disorders with circulating plasma cells is an aggressive variant of plasma cell dyscrasias with relatively poor outcomes. A 75-year-old man was admitted due to anaemia (90 g/L) and thrombocytopenia (9×109/L). Comprehensive metabolic panel showed creatinine of 1.34 mg/dL, total protein of 6 g/dL, and corrected calcium was normal. Peripheral smear review showed 8% circulating atypical plasmacytoid cells. Bone marrow biopsy (BMB) confirmed plasma cell myeloma involving 90%–95% of bone marrow cellularity. Serum protein electrophoresis showed no monoclonal protein. Due to aggressive biology of non-producer variant and outcomes based on circulating plasma cells, he was started on VD-PACE (bortezomib, dexamethasone, cisplatin, doxorubicin, cyclophosphamide and etoposide) chemotherapy. BMB after cycle 1 chemotherapy showed no morphologic, immunophenotypic, or flow cytometric features of a plasma cell neoplasm. Given excellent treatment response cycle 2 was changed to VRD (bortezomib, lenalidomide and dexamethasone). Following two cycles of VRD, he underwent autologous haematopoietic cell transplantation. Day 80 BMB suggested stringent complete response.

  • cancer intervention
  • haematology (incl blood transfusion)
  • oncology
View Full Text

Statistics from


  • Contributors SM worked on the background, case report and discussion. RZ provided us with pathology images. RFC and KC reviewed and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.