- 作者：Al-ola Abdallah ; Shebli Atrash ; Zainab Shahid ; Muzaffar Jameel ; Monica Grazziutti ; Senu Apewokin ; Naveen S. Kumar ; Alejandro Restrepo ; Sarah Waheed ; Frits Van Rhee ; Christoph J. Heuck ; Donald Johann Jr. ; Bart Barlogie ; Saad Z. Usmani ; saad.usmani@carolinashealthcare.org" class="auth_mail
- 关键词：Central nervous system ; Intrathecal chemotherapy ; Myeloma ; Plasma cell leukemia ; Transplant
- 刊名：Clinical Lymphoma Myeloma and Leukemia
- 出版年：June 2014
- 年：2014
- 卷：14
- 期：3
- 页码：211-214
- 全文大小：301 K
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.