Multiple Myeloma Invasion of the Central Nervous System

Schluterman, Keith; Fassas, Athanasios; Hemert, Rudy L. Van; Harik, Sami I.

doi:10.1001/archneur.61.9.1423

Cited by 89 publications

(110 citation statements)

References 23 publications

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“…CNS-MM is responsible for a variety of neurological symptoms, which are more frequently represented by confusion, limb weakness, headache, visual disturbances, gait disturbances, speech disturbances. 4,7 We recently observed a case of CNS-MM after chemotherapy and transplantation of autologous peripheral blood hematopoietic stem cells. Diagnosis was made by multiparameter flow cytometry on a CSF sample, in the presence of normal computed tomography (CT) and magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Myelomatous Meningitis Evaluated by Multiparameter Flow Cytometry : Report of a Case and Review of the Literature

Marini

Carulli

Lari

et al. 2014

J Clin Exp Hematopathol

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Central nervous system (CNS) involvement in multiple myeloma (MM) is uncommon. Among its possible presentations, leptomeningeal involvement of MM, also termed central nervous system myelomatosis (CNS-MM) is rare and is characterized by the presence of neoplastic plasma cells in the cerebrospinal fluid (CSF). So far, 187 cases of CNS-MM have been reported : the great majority of them were diagnosed by cytological assays and flow cytometry was used in only eight cases. We describe a case of CNS-MM in a 62-year-old woman, previously treated with chemotherapy (VTD) and autologous peripheral blood hematopoietic stem cell transplantation for stage IIIB IgG-l MM. After achieving a very good partial response, the patient showed progression of disease, with an extramedullary localization. During administration of second-line therapy, the patient showed severe neurological symptoms. MRI resulted negative. Diagnosis of CNS-MM was made by multiparameter flow cytometry, which showed the presence of CD56 + plasma cells in a CSF sample, in the absence of plasma cell leukemia. In this paper we also present a review of the eight previous cases of CNS-MM diagnosed by flow cytometry. We found that the application of flow cytometry in cases of MM with neurological symptoms allows a rapid diagnosis of CNS-MM and provides useful information about plasma cell phenotype (including CD56 expression). Some cases of CNS-MM are characterized by normal MRI. In addition, some evidences deriving from the review of literature suggest that CSF monitoring by flow cytometry in such cases might be used to evaluate the efficacy of drugs capable of crossing the blood-brain barrier. 〔J Clin Exp Hematop 54 (2) : 129-136, 2014〕

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Section: Introductionmentioning

confidence: 99%

Myelomatous Meningitis Evaluated by Multiparameter Flow Cytometry : Report of a Case and Review of the Literature

Marini

Carulli

Lari

et al. 2014

J Clin Exp Hematopathol

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“…3 These effects can occur as a result of the direct infiltration of the malignant plasma cells, the development of plasmacytomas in the skull or because of metabolic derangements caused by the malignancy. 3 Generally, most patients with CNS myelomas have a very poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…2 Usually, CNS involvement is observed in cases of established residual MM or during a subsequent relapse. 3 This case report describes a patient with MM which manifested initially with cranial diabetes insipidus.…”

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confidence: 99%

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A Case of Multiple Myeloma Presenting with Diabetes Insipidus

Paul¹,

Ruia²,

Saha³

et al. 2017

SQUMJ

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Multiple myeloma (MM) can present with involvement of the central nervous system in the form of nerve palsy, plasma cell masses or, rarely, with endocrinological effects due to involvement of the pituitary gland. Usually, in such cases, the disease has a rapid progression and poor prognosis. We report a 52-year-old man who was admitted to the Kolkata Medical College, Kolkata, India, in 2016 with a prolonged low-grade fever and hypernatremia. Shortly afterwards, the patient began to complain of increased urinary frequency and drowsiness. The hypernatremia was treated with intranasal desmopressin and free water replacement. Serum protein electrophoresis and an immunofixation study revealed an immunoglobulin G-κ monoclonal band. Magnetic resonance imaging of the pituitary gland revealed the absence of a posterior bright spot and spotty infiltration of the pituitary fossa. A bone marrow biopsy confirmed a diagnosis of cranial diabetes insipidus due to posterior pituitary MM infiltration.

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“…This has been referred by other studies based on cytogenetic and molecular analysis, as well [7][8] . The invasion of the central system by the multiple myeloma in the form of a leptomeningeal myelomatosis, an extramedullar propagation, or more rarely an intracerebral expansion, are frequently related to a less differentiated cellular morphology, frequently of the plasmablastic type, with a high-risk genetic profile, and also intensive previous therapy; the further course of the disease in these patients is usually very complicated and difficult to improve therapeutically [9][10][11] . In our observation, the primomanifestation of multiple myeloma in form of a focal neurologic symptoms allowed effective treatment of the disease, i.e.…”

Section: Discussionmentioning

confidence: 99%