The combination topotecan, temozolomide and dexamethasone associated with radiotherapy as treatment of central nervous system myeloma relapse.
A 46-year-old woman with IgA-lambda myeloma in partial remission, after a tandem autologous hematopoietic stem cells transplantation, complained of progressive lower back pain associated with paraplegia and neurological bladder 6 months after the second transplant. A lumbar puncture revealed atypical malignant plasma cells in the cerebral spinal fluid associated with multiple foci of altered signal intensity of brain and spinal cord demonstrated by magnetic resonance. Considering the lack of efficacious chemotherapies for neurological myeloma, an experimental systemic treatment with topotecan, temozolamide, and dexamethasone associated with concurrent radiotherapy of brain and spinal cord was initiated. During this treatment, the patient rapidly improved with disappearance of back pain, paresthesia, and urinary incontinence lasting 5 months, before dying of progressive disease. The proposed systemic chemotherapy associated with concurrent radiotherapy may have an antitumor activity against MM with CNS involvement.
Annibali
Ombretta
O
Ematologia, Università Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy. o.annibali@unicampus.it.
Nobile
Carolina
C
Ematologia, Università Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Greco
Rosa
R
Ematologia, Università Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Cellini
Francesco
F
Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy.
Quattrocchi
Carlo Cosimo
CC
Radiologia, Università Campus Bio-Medico, Rome, Italy.
Tirindelli
Maria Cristina
MC
Ematologia, Università Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Petrucci
Maria Teresa
MT
Sezione di Ematologia, Dipartimento di Biotecnologie Cellulari ed Ematologia, Università "La Sapienza", Rome, Italy.
Avvisati
Giuseppe
G
Ematologia, Università Campus Bio-Medico, Via Alvaro del Portillo, 21, 00128, Rome, Italy.