BACKGROUND: Although neurologic manifestations often complicate the course of patients with multiple myeloma (MM), direct central nervous system invasion is rare. OBJECTIVE: To describe the neurologic symptoms and signs, imaging, cerebrospinal fluid findings, and the clinical course of patients with central nervous system myeloma invasion, all of whom had leptomeningeal myelomatosis. DESIGN AND PARTICIPANTS: Review of 23 patients with MM and leptomeningeal myelomatosis proven by malignant plasma cells in their cerebrospinal fluid. SETTING: Tertiary-care university medical center. RESULTS: Twenty-one patients had advanced-stage MM. Leptomeningeal myelomatosis was diagnosed up to 29 months (median, 13 months) after diagnosis of MM. Symptoms precipitating neurologic evaluation included manifestations of diffuse cerebral dysfunction, cranial nerve palsies, and spinal radiculopathies. Cerebrospinal fluid was abnormal in all patients, usually exhibiting pleocytosis and elevated protein content, plus positive cytologic findings. Specific magnetic resonance imaging findings suggestive of central nervous system invasion were found in 70% of the patients. These included leptomeningeal contrast enhancement and evidence of meningeal-based lesions sometimes masquerading as intraparenchymal lesions. Despite aggressive systemic and local treatment, the outcome was poor, reflecting the aggressiveness of the underlying MM. CONCLUSION: Leptomeningeal myelomatosis, although rare, should be considered in patients with MM and symptoms suggestive of widespread nervous system involvement.
BACKGROUND: Although neurologic manifestations often complicate the course of patients with multiple myeloma (MM), direct central nervous system invasion is rare. OBJECTIVE: To describe the neurologic symptoms and signs, imaging, cerebrospinal fluid findings, and the clinical course of patients with central nervous system myeloma invasion, all of whom had leptomeningeal myelomatosis. DESIGN AND PARTICIPANTS: Review of 23 patients with MM and leptomeningeal myelomatosis proven by malignant plasma cells in their cerebrospinal fluid. SETTING: Tertiary-care university medical center. RESULTS: Twenty-one patients had advanced-stage MM. Leptomeningeal myelomatosis was diagnosed up to 29 months (median, 13 months) after diagnosis of MM. Symptoms precipitating neurologic evaluation included manifestations of diffuse cerebral dysfunction, cranial nerve palsies, and spinal radiculopathies. Cerebrospinal fluid was abnormal in all patients, usually exhibiting pleocytosis and elevated protein content, plus positive cytologic findings. Specific magnetic resonance imaging findings suggestive of central nervous system invasion were found in 70% of the patients. These included leptomeningeal contrast enhancement and evidence of meningeal-based lesions sometimes masquerading as intraparenchymal lesions. Despite aggressive systemic and local treatment, the outcome was poor, reflecting the aggressiveness of the underlying MM. CONCLUSION:Leptomeningeal myelomatosis, although rare, should be considered in patients with MM and symptoms suggestive of widespread nervous system involvement.
Authors: Artur Jurczyszyn; Norbert Grzasko; Alessandro Gozzetti; Jacek Czepiel; Alfonso Cerase; Vania Hungria; Edvan Crusoe; Ana Luiza Miranda Silva Dias; Ravi Vij; Mark A Fiala; Jo Caers; Leo Rasche; Ajay K Nooka; Sagar Lonial; David H Vesole; Sandhya Philip; Shane Gangatharan; Agnieszka Druzd-Sitek; Jan Walewski; Alessandro Corso; Federica Cocito; Marie-Christine M Vekemans; Erden Atilla; Meral Beksac; Xavier Leleu; Julio Davila; Ashraf Badros; Ekta Aneja; Niels Abildgaard; Efstathios Kastritis; Dorotea Fantl; Natalia Schutz; Tomas Pika; Aleksandra Butrym; Magdalena Olszewska-Szopa; Lidia Usnarska-Zubkiewicz; Saad Z Usmani; Hareth Nahi; Chor S Chim; Chaim Shustik; Krzysztof Madry; Suzanne Lentzsch; Alina Swiderska; Grzegorz Helbig; Renata Guzicka-Kazimierczak; Nikoletta Lendvai; Anders Waage; Kristian T Andersen; Hirokazu Murakami; Sonja Zweegman; Jorge J Castillo Journal: Am J Hematol Date: 2016-04-24 Impact factor: 10.047
Authors: Veeravich Jaruvongvanich; Ittikorn Spanuchart; Pichaya O-Charoen; Christian Kitamura; Lauren Sumida; Marina Roytman Journal: Hawaii J Med Public Health Date: 2016-04