Bendamustine in combination with high‐dose radiotherapy and thalidomide is effective in treatment of multiple myeloma with central nervous system involvement

Nahi, Hareth; Svedmyr, Erik; Lerner, R.

doi:10.1111/ejh.12247

Cited by 16 publications

(18 citation statements)

References 9 publications

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“…Topotecan and temozolomide use has shown rapid improvement in neurological symptoms in one case report, but the response was only short lived [53]. Recently bendamustine, thalidomide, and dexamethasone showed significant response in two cases with intraparenchymal disease [54]. Bendamustine was also used in CNS lymphoma with some success [55].…”

Section: Chemotherapymentioning

confidence: 99%

Retracted: Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma

et al. 2014

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Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM. Less common MM isotypes have been overrepresented in LMM. CNS relapse occurred mostly in patients with Durie-Salmon stage III MM. Despite treatments, standard or experimental, the survival rates of LMM remain dismal. Monitoring high risk patients closely, even after achieving complete remission, may be useful in early detection of LMM. As we gain better understanding of LMM, we recommend that future research and clinical care focus on earlier diagnosis and development of more efficient CNS-directed therapy to improve survival in this patient population.

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Section: Chemotherapymentioning

confidence: 99%

Retracted: Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma

et al. 2014

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“…The penetration of bortezomib through the blood−brain barrier was limited in animal models . Bendamustine can potentially be used in the management of CNS MM, as administration of this agent resulted in clinical improvement of patients with CNS lymphoma .…”

Section: Discussionmentioning

confidence: 99%

Central nervous system involvement by multiple myeloma: A multi‐institutional retrospective study of 172 patients in daily clinical practice

et al. 2016

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The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22%) were diagnosed with CNS involvement at the time of initial MM diagnosis and 134 (78%) at relapse/progression. Upon diagnosis of CNS MM, 97% patients received initial therapy for CNS disease, of which 76% received systemic therapy, 36% radiotherapy and 32% intrathecal therapy. After a median follow-up of 3.5 years, the median overall survival (OS) from the onset of CNS involvement for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively (p<0.001). At least one previous line of therapy for MM before the diagnosis of CNS disease and >1 cytogenetic abnormality detected by FISH were independently associated with worse OS. The median OS for patients with 0, 1 and 2 of these risk factors were 25 months, 5.5 months and 2 months, respectively (p<0.001). Neurological manifestations, not considered chemotherapy-related, observed at any time after initial diagnosis of MM should raise a suspicion of CNS involvement. Although prognosis is generally poor, the survival of previously untreated patients and patients with favorable cytogenetic profile might be prolonged due to systemic treatment and/or radiotherapy.

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“…However, durable responses have been reported using bendamustine in combination with thalidomide. 45 In addition to systemic anti-MM therapy, CNS irradiation and IT chemotherapy have been shown to improve the duration of response. 35,37,38 Regarding CNS irradiation, both cranial and cranio-spinal irradiation are reported in the literature.…”

Section: Spmentioning

confidence: 99%

How I treat extramedullary myeloma

Touzeau

Moreau

2016

Blood

150

165

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Extramedullary myeloma (EMM) is defined by the presence of plasma cells (PCs) outside the bone marrow in a patient with multiple myeloma (MM). Using sensitive imaging techniques including magnetic resonance imaging and positron emission tomography/computed tomography, EMM may be found in up to 30% of MM patients across the overall disease course. The molecular mechanisms underlying the hematogenous spread of PCs outside the bone marrow are only partially known and involve hypoxia and an altered expression of adhesion molecules. Extramedullary disease is associated with adverse prognostic factors (ie, high lactate dehydrogenase level, 17p deletion, and high-risk gene expression profile). The prognosis of EMM is poor, and the median overall survival of patients who experience an extramedullary relapse is <6 months. The adverse prognosis is less pronounced in patients with bone-related plasmacytomas than in those with hematogenous EMM. EMM patients should be considered as having high-risk myeloma and treated accordingly. However, EMM clinical situations are extraordinarily heterogeneous, and their management is particularly challenging. In the present review, a case-and-comment format is used to describe our approach to the management of EMM.

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Bendamustine in combination with high‐dose radiotherapy and thalidomide is effective in treatment of multiple myeloma with central nervous system involvement

Cited by 16 publications

References 9 publications

Retracted: Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma

Retracted: Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma

Central nervous system involvement by multiple myeloma: A multi‐institutional retrospective study of 172 patients in daily clinical practice

How I treat extramedullary myeloma

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