Plasma cell malignancies are radioresponsive. Radiation is used as primary or adjunctive therapy of plasma cell disorders (PCDs). Palliation of symptoms is the commonest indication for radiation to the skeletal and soft tissue myelomatous lesions. Other indications include pretransplant conditioning, myeloma-related cord compression, or impending pathological fractures. Radiation is also utilized in the management of solitary osseous and extramedullary plasmacytomas, POEMS syndrome with a limited number of lesions, localized AL amyloidosis and rarely, Waldenström’s macroglobulinemia. Anecdotal reports outlining successful use of radiation with novel anti-myeloma agents exist. This chapter focuses on conventional radiation and chemo-radiation-based management strategies in PCDs.
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