Partial response of meningeal myeloma to craniospinal radiotherapy

Abstract

Concomitant occurrence of meningeal involvement and thoracic plasmacytoma was observed in a patient with IgA lambda myeloma. Cerebrospinal fluid analysis revealed IgA‐λ paraprotein and pathological plasma cells. CT scan of the chest and lumbar myelogram excluded spinal cord compression. The patient partially responded to craniospinal irradiation but succumbed to rapidly progressive myeloma 20 weeks following diagnosis of meningeal involvement.

Central nervous system myelomatosis: review of the literature

“…We found 37 case reports, describing isolated CNS MM cases, and two reports of series of 18 and 54 patients respectively (3, 4). The data of a total of 109 patients were reviewed (3–77).…”

Cerebral and meningeal multiple myeloma after autologous stem cell transplantation. A case report and review of the literature

“…The definition of MeM used in this paper is the pres- ence of plasma cells in the CSF, in a patient with MM. Evidence of monoclonality of the plasma cells would be optimal [4,12], because plasma cells can be seen in the CSF in other conditions both infectious and noninfectious [4,15,47]. But if such information cannot be obtained immediately, this should not in our opinion delay treatment.…”

Meningeal Involvement in Multiple Myeloma

“…The immunoglobulin types reported involved IgG, IgA, IgD and light chain; our case is the fourth report of light chain myeloma with meningeal involvement. 32,43,45 Of the cases (including ours) on which information was available, 9 were IgA, 4,7,9,11,12,16,[38][39][40] 10 were IgG. 13,21,22,24,25,27,31 5 were IgD 2,17,36,46 and 4 had light chain immunoglobulin only (2 with lambda and 2 with kappa chain).…”

“…[1][2][3][4]7,9,[11][12][13][16][17][18][21][22][23]25,27,[29][30][31][32][36][37][38][39][40][42][43][44][45][46] Our case is the 38th. The immunoglobulin types reported involved IgG, IgA, IgD and light chain; our case is the fourth report of light chain myeloma with meningeal involvement.…”

“…33,40 Immunocytochemical techniques are very useful for the identification of monoclonality of plasma cells and for the diagnosis of myeloma with cavitary involvement. 35 The neoplastic plasma cells can be best identified by the presence of monoclonal immunoglobulins in their cytoplasm, 35 as in our case and eight prior cases with meningeal myeloma, 4,9,17,21,23,31,38,39 but in two of them, immunocytochemistry was performed only postmortem. 21,39 The best treatment of meningeal myeloma has not been established.…”