Meningeal and cerebral involvement in multiple myeloma patients.
Cerebral involvement is an unusual complication in multiple myeloma: herein four patients who presented myelomatous meningitis with multiple intraparenchymal lesions or a localized cerebral plasmacytoma are described. Two of these patients relapsed with meningeal involvement and a very limited disease outside the central nervous system after an initial complete remission obtained with induction chemotherapy. In the other two cases, the cerebral tumor appeared during first-line treatment. Cytological examination of the cerebrospinal fluid and magnetic resonance were essential for diagnosis. Different modalities of treatment were used, including intrathecal chemotherapy, cranial irradiation, and systemic chemotherapy with high-dose methotrexate and cytarabine, achieving improvement of neurological symptoms in three of four patients.
Patriarca
F
F
Division of Hematology and Department of Bone Marrow Transplantation, Udine University Hospital, P.le S. Maria della Misericordia, 33100 Udine, Italy. Ematologia@uniud.it
Zaja
F
F
Silvestri
F
F
Sperotto
A
A
Scalise
A
A
Gigli
G
G
Fanin
R
R
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002555:Cerebrospinal Fluid / Q000166:cytology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000032:analysis; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D009101:Multiple Myeloma / Q000134:cerebrospinal fluid / Q000150:complications* / Q000628:therapy; D010954:Plasmacytoma / Q000134:cerebrospinal fluid / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011241:Prednisone / Q000627:therapeutic use; D011878:Radiotherapy; D012008:Recurrence; D012074:Remission Induction
D000970:Antineoplastic Agents; D002556:Cerebrospinal Fluid Proteins; D005938:Glucocorticoids; D007147:Immunoglobulin Light Chains; D007145:Immunoglobulin kappa-Chains; D011241:Prednisone