P14.04 Characteristics of cerebrospinal fluid in hematologic malignancy

Abstract

Abstractsiii102 NEURO-ONCOLOGY • MAY 2017 C677T, 58.8% [45.2-71.3] were either heterozygous or homozygous for A1298C, and 25.5% [15.5-38.9] were compound heterozygotes. Peak methotrexate levels were 656.0 [579.6-730.4] in patients with a mutation and 513. 43 [376.3-605.5] in non-mutated patients (p=0.11). Serum methotrexate levels >0.05 on day 6 only occurred in patients with a mutation (34.1%, p=0.06). Any grade 2 or greater toxicity occurred in 42.9% of non-mutated and 84.1% of mutated patients (p=0.031). Grade 3 toxicities were only observed in patients with at least one mutation: 14.8% [5.92-32.5] and 23.3% [11.8-40.9] in C677T and A1298C mutations respectively. There was no statistically significant difference between the two mutations (p=0.51). We hypothesized that overall survival might be longer in patients with MTHFR SNPs, but in our cohort that difference was not statistically significant: 730 days in the mutated vs. 284 days in the non-mutated patients (p=0.4). The frequency of MTHFR SNPs was dramatically greater in our lymphoma cohort than in the general population (~33% for C766T and 24-40% for A1298C mutations) raising the possibility that these mutations are themselves associated with CNS lymphomas. CONCLUSIONS: MTHFR mutations are associated with an increased frequency of toxicity and prolonged need for leucovorin rescue. Larger patient series may disclose a survival advantage for patients with MTHFR mutations. These mutations may be associated with the occurrence of CNS lymphoma. Central nervous system invasion of multiple myeloma is a rare extramedullary form of the disease, presenting as intraparenchymal lesions, leptomeningeal disease, or via direct dural invasion. Survival of leptomeningeal myelomatosis in historical series is considered to be extremely poor, but seems to be improving in the era of novel therapy, namely proteosome inhibitors and immunomodulatory class drugs. Here we present the case of a 48 year-old male with isolated central nervous system relapse of multiple myeloma who had multiple rapidly progressive intraparenchymal myeloma lesions, cauda equina lesions, as well as leptomeningeal myelomatosis that developed years after complete response to autologous stem cell transplant. This patient's central nervous system disease progressed following systemic high-dose methotrexate, but demonstrated a durable partial response to proton beam craniospinal irradiation combined with immunomodulatory chemotherapy using pomalidomide plus dexamethasone. Little is known about the use of proton radiation therapy in the treatment of plasma cell neoplasms as compared to other hematologic malignancies (such as leukemia), nor about its efficacy, with no published reports to our knowledge. Finally, we review the current literature regarding treatment of both intraparenchymal and leptomeningeal myelomatosis. P14.02 PROTON RADIATION THERAPY COMBINED WITH IMMUNOMODULATORY DRUGS FOR CENTRAL NERVOUS P14.03 MENINGES METASTASES IN BREAST CANCER-ONE CENTER STUDY EXPERIENCE OF CONCOMITANT THERAPY INTRA...

Kesintasan Pasien Dengan Metastasis Leptomeningeal Yang Dirawat Di Bagian Neurologi Rumah Sakit Kanker Dharmais Dan Rsupn DR Cipto Mangunkusumo

“…Selain itu dengan meningkatnya terapi suportif dan regimen kemoterapi serta kegagalan obat-obatan saat ini untuk menembus sawar darah otak juga merupakan faktor yang berkontribusi terhadap peningkatan insidensi ML. 1,2 ML atau disebut juga karsinomatosis meningeal atau neoplastik meningitis merupakan suatu penyakit akibat penyebaran tumor primer intrakranial maupun tumor ekstrakranial secara difus atau terlokalisir menginvasi meningen dan subaraknoid. Pada tahun 1870, ahli patologi dari Swiss bernama Eberth menemukan dari hasil otopsi bahwa ada infiltrasi sel-sel karsinoma pada leptomeningen pasien dengan kanker paru, sementara hasil patologi anatomi tidak menemukan adanya in amasi pada meningen.…”