Leptomeningeal relapse of multiple myeloma following allogeneic stem cell transplantation.
Progressive multiple myeloma may manifest features of 'de-differentiation', including a plasmablastic appearance, failure to secrete paraprotein, extramedullary involvement, and resistance to treatment. A 44-year-old woman with kappa-light chain myeloma underwent allogeneic stem cell transplantation (SCT). Twenty months later she developed paraspinal plasmablastic myeloma in the absence of paraprotein in urine or myeloma in the marrow. The paraspinal masses responded to chemotherapy. At 30 months she developed myelomatous meningitis, which proved resistant to intrathecal chemotherapy, irradiation, and donor lymphocyte infusion (DLI). The leptomeningeal disease led to death at 38 months. This is the first report of leptomeningeal relapse of myeloma after allografting.
Savage
David G
DG
Hematology/Oncology Division, Columbia University College of Physicians and Surgeons, 177 Fort Washington Avenue, New York City, NY 10032, USA. savege@cancercenter.columbia.edu
Mears
J Gregory
JG
Balmaceda
Casilda
C
Rescigno
John
J
Shendrik
Igor
I
Mansukhani
Mahesh
M
Orazi
Attilio
A
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002454:Cell Differentiation; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000008:administration & dosage; D004164:Diphosphonates / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use; D008558:Melphalan / Q000008:administration & dosage; D008578:Meninges / Q000473:pathology*; D008727:Methotrexate / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy; D014411:Neoplastic Stem Cells / Q000473:pathology; D010014:Osteolysis / Q000188:drug therapy / Q000209:etiology; D000077268:Pamidronate; D020335:Paraparesis / Q000209:etiology; D012008:Recurrence; D016879:Salvage Therapy; D012640:Seizures / Q000209:etiology; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014750:Vincristine / Q000008:administration & dosage
D004164:Diphosphonates; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007376:Interleukin-2; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D000077268:Pamidronate; D008558:Melphalan; D008727:Methotrexate