TY - JOUR
T1 - Myelomatous Involvement of the Central Nervous System
AU - Paludo, Jonas
AU - Painuly, Utkarsh
AU - Kumar, Shaji
AU - Gonsalves, Wilson I.
AU - Rajkumar, Vincent
AU - Buadi, Francis
AU - Lacy, Martha Q.
AU - Dispenzieri, Angela
AU - Kyle, Robert A.
AU - Mauermann, Michelle L.
AU - McCurdy, Arleigh
AU - Dingli, David
AU - Go, Ronald S.
AU - Hayman, Suzanne R.
AU - Leung, Nelson
AU - Lust, John A.
AU - Lin, Yi
AU - Gertz, Morie A.
AU - Kapoor, Prashant
N1 - Funding Information:
P.K. has received research funding from Takeda, Onyx, and Celgene and consulting fees from Celgene (all institutional). S.K. has received research support from Celgene, Novartis, Onyx, Millennium, Sanofi, and Janssen. A.D. has received research support from Celgene, Takeda, Pfizer, Janssen, and Alnylam. D.D. has received research funding from Millennium, Karyopharm, and Amgen. M.A.G. has received research support from Ionis Pharmaceuticals and Prothena and honoraria from Celgene, Millennium Pharmaceuticals, and Novartis. The remaining authors declare that they have no competing interests.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Myelomatous involvement of the central nervous system (CNS) is an uncommon complication that portends a poor prognosis in patients with multiple myeloma (MM). Limited data exist regarding the optimal management of CNS MM. In the present case-control study, we examined the clinical presentation, diagnosis, treatment, and outcomes of CNS MM patients compared with a control group of MM patients without CNS involvement, matched by date of diagnosis and gender. Introduction Limited data exist with respect to the outcome and optimal treatment of patients with myelomatous involvement of the central nervous system (CNS). Materials and Methods Of 4060 patients with multiple myeloma (MM), evaluated at Mayo Clinic from 1998 to 2014, 29 (0.7%) had identifiable CNS involvement, established by the presence of atypical plasma cells in the cerebrospinal fluid (CSF) and/or identification of intraparenchymal or meningeal involvement on magnetic resonance imaging (MRI). A cohort of 87 MM patients without CNS disease served as the control group (1:3), matched by diagnosis date and gender. Results Plasma cells were detected in the CSF in 87% and MRI findings consistent with CNS involvement were noted in 82% of the patients. A bone marrow plasma cell labeling index of ≥ 3%, the presence of disease at other extramedullary sites, or peripheral blood plasma cells of > 800 per 150,000 events were associated with an odds ratio of 7.1, 10.3, and 14, respectively, for the risk of CNS involvement. Overall survival (OS) from the diagnosis of MM was significantly shorter in the CNS-MM group (median 40 months; 95% confidence interval [CI], 24-56 months) than in the control group (median, 93 months; 95% CI, 67-129 months). OS was 3.4 months from the detection of CNS disease. Patients who underwent autologous stem cell transplantation after CNS involvement (n = 7) had a median OS of 19 months (95% CI, 10-67 months) from the detection of CNS involvement. Conclusion Myelomatous involvement of the CNS is a rare complication that portends a poor survival. Current therapeutic approaches appear to be largely ineffective for this subset of patients with MM.
AB - Myelomatous involvement of the central nervous system (CNS) is an uncommon complication that portends a poor prognosis in patients with multiple myeloma (MM). Limited data exist regarding the optimal management of CNS MM. In the present case-control study, we examined the clinical presentation, diagnosis, treatment, and outcomes of CNS MM patients compared with a control group of MM patients without CNS involvement, matched by date of diagnosis and gender. Introduction Limited data exist with respect to the outcome and optimal treatment of patients with myelomatous involvement of the central nervous system (CNS). Materials and Methods Of 4060 patients with multiple myeloma (MM), evaluated at Mayo Clinic from 1998 to 2014, 29 (0.7%) had identifiable CNS involvement, established by the presence of atypical plasma cells in the cerebrospinal fluid (CSF) and/or identification of intraparenchymal or meningeal involvement on magnetic resonance imaging (MRI). A cohort of 87 MM patients without CNS disease served as the control group (1:3), matched by diagnosis date and gender. Results Plasma cells were detected in the CSF in 87% and MRI findings consistent with CNS involvement were noted in 82% of the patients. A bone marrow plasma cell labeling index of ≥ 3%, the presence of disease at other extramedullary sites, or peripheral blood plasma cells of > 800 per 150,000 events were associated with an odds ratio of 7.1, 10.3, and 14, respectively, for the risk of CNS involvement. Overall survival (OS) from the diagnosis of MM was significantly shorter in the CNS-MM group (median 40 months; 95% confidence interval [CI], 24-56 months) than in the control group (median, 93 months; 95% CI, 67-129 months). OS was 3.4 months from the detection of CNS disease. Patients who underwent autologous stem cell transplantation after CNS involvement (n = 7) had a median OS of 19 months (95% CI, 10-67 months) from the detection of CNS involvement. Conclusion Myelomatous involvement of the CNS is a rare complication that portends a poor survival. Current therapeutic approaches appear to be largely ineffective for this subset of patients with MM.
KW - Extramedullary
KW - High-risk
KW - Leptomeningeal
KW - Multiple myeloma
KW - Outcome
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U2 - 10.1016/j.clml.2016.08.010
DO - 10.1016/j.clml.2016.08.010
M3 - Article
C2 - 27624224
AN - SCOPUS:84994545294
VL - 16
SP - 644
EP - 654
JO - Clinical Lymphoma
JF - Clinical Lymphoma
SN - 2152-2669
IS - 11
ER -