Isolated central nervous system relapse of multiple myeloma post autologous stem cell transplant- A rare presentation

Mittal, Abhenil; Pushpam, Deepam; Kumar, Lalit

doi:10.1016/j.lrr.2020.100207

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…Relapse of MM after ASCT usually presents with a recurrence of plasma cells in the marrow. [ 22 ] Some authors have reported that the presentation of localized EM plasmacytoma after ASCT in MM patients is very unusual. [ 11 , 26 ] However, in the study by Zeiser et al ., the relapse rate after ASCT was 63%.…”

Section: Discussionmentioning

confidence: 99%

“…Isolated CNS relapse after ASCT is extremely rare, with only 14 cases reported. [ 20 , 22 ] Among the isolated CNS relapse cases, 43% had parenchymal lesions. [ 3 , 5 , 22 , 25 , 29 , 32 ] Despite ASCT, the prognosis after CNS relapse is extremely poor, with a very short median survival.…”

Section: Discussionmentioning

confidence: 99%

“…[ 20 , 22 ] Among the isolated CNS relapse cases, 43% had parenchymal lesions. [ 3 , 5 , 22 , 25 , 29 , 32 ] Despite ASCT, the prognosis after CNS relapse is extremely poor, with a very short median survival. [ 14 , 20 , 22 , 25 , 29 ] For MM patients who are ASCT candidates, IgA MM has been recognized as a risk factor that adversely affects survival.…”

Section: Discussionmentioning

confidence: 99%

“…[3,5,22,25,29,32] Despite ASCT, the prognosis after CNS relapse is extremely poor, with a very short median survival. [14,20,22,25,29] For MM patients who are ASCT candidates, IgA MM has been recognized as a risk factor that adversely affects survival. [9,12] Li et al noticed that more patients with EM plasmacytoma at the time of MM diagnosis carried the IgA subtype than those without plasmacytoma.…”

Section: Discussionmentioning

confidence: 99%

“…[31] Central nervous system (CNS) involvement of MM is rare, occurring in 0.7-1% of the patients. [1,22,24,28] It can emerge in newly diagnosed, relapsed, or refractory MM patients; however, it is more frequent in relapsed cases and younger patients. [1,16,21,28] e median time from MM diagnosis to CNS involvement is approximately two years.…”

Section: Introductionmentioning

confidence: 99%

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Multiple myeloma extramedullary relapse at the sellar and suprasellar region after autologous stem cell transplantation

De Jesus

2024

Surgical Neurology International

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Background: The effectiveness of autologous stem cell transplantation (ASCT) in preventing the development of central nervous system (CNS) plasmacytomas in multiple myeloma (MM) patients is not well understood. An ASCT patient who developed CNS extramedullary (EM) lesions is presented. The literature was reviewed for similar cases in which the transplant did not prevent the development of CNS lesions. Case Description: A 42-year-old female was evaluated after complaining of a sudden severe headache and complete vision loss. Two years before, she was diagnosed with MM and treated with systemic chemotherapy and an ASCT. The patient was in remission; however, a new brain magnetic resonance imaging showed a sellar and suprasellar mass. Additional smaller lesions were identified at the parietal convexity and the splenium. Due to the history of MM and evidence of multiple intracranial lesions, it was suspected that the lesions were secondary to EM disseminated disease. Due to the sudden loss of vision, the patient underwent a right frontotemporal craniotomy with subtotal sellar/suprasellar tumor resection to decompress the optic nerves. Histopathological examination of the lesion confirmed an immunoglobulin A (IgA) EM sellar and suprasellar plasmacytoma. Conclusion: In the majority of MM patients with CNS involvement, ASCT did not prevent the development of EM sellar plasmacytomas. The IgA subtype is associated with more aggressive disease biology for CNS relapses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multiple myeloma extramedullary relapse at the sellar and suprasellar region after autologous stem cell transplantation

De Jesus

2024

Surgical Neurology International

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Multiple myeloma with isolated central nervous system relapse after autologous stem cell transplantation: A case report and review of the literature

Wang

Zhang

et al. 2022

Front. Oncol.

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Patients with multiple myeloma (MM) rarely present with central nervous system (CNS) involvement as a manifestation of extramedullary disease (EMD), a condition that is associated with poor prognosis. CNS relapse without evidence of systemic involvement is even rarer, and there is no standardized treatment because there are only few case reports. We present a 47-year-old female who was diagnosed with nonsecretory multiple myeloma (NSMM) 9 years previously. She had a complete remission after receiving aggressive therapies, including high-dose chemotherapy and autologous stem cell transplantation (ASCT). However, after 7 years of progression-free survival, she had CNS relapse without evidence of systemic involvement. We switched to a salvage regimen consisting of high-dose methotrexate with lenalidomide. She achieved rapid clinical improvement, with a reduction in cerebrospinal fluid plasmacytosis of more than 80%, and no notable side effects. Our description of this unique case of a patient with MM and isolated CNS relapse after ASCT provides a reference for physicians to provide more appropriate management of these patients. We also reviewed previously reported cases and summarized the outcomes of isolated CNS relapse after ASCT, and discuss the pathogenesis and possible treatment strategies for MM with isolated CNS relapse.

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難治性多発性骨髄腫に合併した髄膜癌腫症の1例

2021

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Isolated central nervous system relapse of multiple myeloma post autologous stem cell transplant- A rare presentation

Cited by 3 publications

References 15 publications

Multiple myeloma extramedullary relapse at the sellar and suprasellar region after autologous stem cell transplantation

Multiple myeloma extramedullary relapse at the sellar and suprasellar region after autologous stem cell transplantation

Multiple myeloma with isolated central nervous system relapse after autologous stem cell transplantation: A case report and review of the literature

難治性多発性骨髄腫に合併した髄膜癌腫症の1例

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