Marc C Chamberlain1, Michael Glantz. 1. Department of Neurology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington 98109, USA. ChambeMC@u.washington.edu
Abstract
BACKGROUND: The most frequent nervous system complications of multiple myeloma are peripheral neuropathy and epidural spinal cord compression. Myelomatous meningitis (MM) has been considered rare. The current study was performed to characterize the clinical presentation, treatment, and outcome of MM. METHODS: The study was a case series of 14 patients with cerebrospinal fluid (CSF)-positive MM who were treated at a tertiary care university medical center. RESULTS: Fourteen patients with advanced multiple myeloma were treated with involved-field radiotherapy (to the brain in 5 patients and the spine in 6 patients) and intra-CSF chemotherapy (ventricular in 10 patients and lumbar in 4 patients). The best response to treatment included 6 partial responses and 8 patients with progressive disease. The median duration of response was 2.5 months (range, 0-6 months). Cause of death was progressive neurologic disease in 6 patients, combined systemic and neurologic disease in 6 patients, and systemic disease progression in 2 patients. CONCLUSIONS: MM is rare and morbid entity (6-month neurologic disease progression-free survival rate of 7%), and appears to be no more responsive to treatment than solid tumor carcinomatous meningitis.
BACKGROUND: The most frequent nervous system complications of multiple myeloma are peripheral neuropathy and epidural spinal cord compression. Myelomatous meningitis (MM) has been considered rare. The current study was performed to characterize the clinical presentation, treatment, and outcome of MM. METHODS: The study was a case series of 14 patients with cerebrospinal fluid (CSF)-positive MM who were treated at a tertiary care university medical center. RESULTS: Fourteen patients with advanced multiple myeloma were treated with involved-field radiotherapy (to the brain in 5 patients and the spine in 6 patients) and intra-CSF chemotherapy (ventricular in 10 patients and lumbar in 4 patients). The best response to treatment included 6 partial responses and 8 patients with progressive disease. The median duration of response was 2.5 months (range, 0-6 months). Cause of death was progressive neurologic disease in 6 patients, combined systemic and neurologic disease in 6 patients, and systemic disease progression in 2 patients. CONCLUSIONS: MM is rare and morbid entity (6-month neurologic disease progression-free survival rate of 7%), and appears to be no more responsive to treatment than solid tumor carcinomatous meningitis.
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