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- Title
Patterns of central nervous system involvement in relapsed and refractory multiple myeloma.
- Authors
Abdallah, Al-Ola; Atrash, Shebli; Shahid, Zainab; Jameel, Muzaffar; Grazziutti, Monica; Apewokin, Senu; Kumar, Naveen S; Restrepo, Alejandro; Waheed, Sarah; Van Rhee, Frits; Heuck, Christoph J; Johann Jr, Donald; Barlogie, Bart; Usmani, Saad Z
- Abstract
BACKGROUND: Invasion of CNS in MM is an extremely rare occurrence that is associated with advanced disease with poor prognosis. PATIENTS AND METHODS: Our MM database identified 35 CNS MM cases presenting between January 1996 and March 2012. Descriptive analyses were performed on available data on patient characteristics, disease course, and outcomes. RESULTS: The mean age at diagnosis was 55.4 years; 23.5% (n = 8) patients had elevated levels of beta-2-microglobulin > 5.5 mg/L; 68.6% (n = 24) of patients had elevated lactate dehydrogenase (LDH) levels (>= 2 times upper limit of normal); and 14% (n = 5) of patients had secondary plasma cell leukemia. Magnetic resonance imaging (MRI), which was performed in 34 patients, showed diffuse or localized leptomeningeal disease in 20 patients (58.8%). Monoclonal malignant plasma cells were found by CSF analysis in all 35 patients. In total, 31 patients received chemotherapy, including intrathecal chemotherapy as a part of their treatment, with a median survival of 4 months after CNS MM diagnosis. DISCUSSION: In our experience, CNS MM is an aggressive terminal disease feature associated with high beta-2-microglobulin level, high LDH level, and secondary plasma cell leukemia. This study highlights an unmet need in this subset of patients with high-risk, relapsed or refractory MM. CONCLUSION: Achieving adequate CSF penetration while limiting the off-target effects needs to be considered in MM-specific novel drug development.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2014, Vol 14, Issue 3, p211
- ISSN
2152-2650
- Publication type
Journal Article
- DOI
10.1016/j.clml.2013.11.004