title: Extramedullary intracranial localization of multiple myeloma and treatment with novel agents: a retrospective survey of 50 patients.
abstract: BACKGROUND
  Intracranial involvement in multiple myeloma is extremely rare. The effect of new drugs (eg, thalidomide, bortezomib, lenalidomide) with respect to old drugs (eg, alkylators, steroids) has not been reported.
  
  
  METHODS
  We collected clinical and biological data of patients presenting with an osteo-dural or primary dural multiple myeloma (OD-DMM) or a central nervous system myelomatosis (CNS-MM) by sending a questionnaire to the centers of the Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA).
  
  
  RESULTS
  A total of 50 patients were registered. New therapies were used in 35 patients, whereas 15 patients received old treatments. Twenty-five out of 50 patients obtained a complete remission or a very good partial remission (CR+VGPR). Overall survival (OS) for CNS-MM was 6 months, for OD-DMM 25 months. OS was 25 months for patients treated with new agents versus 8 months with old agents. Improved OS and progression-free survival were predicted by response (CR+VGPR) and by patients who underwent stem cell transplantation versus chemotherapy. β2-Microglobulin >5 mmol/L was a poor prognostic factor. Multivariate analysis showed poor survival for patients with β2-microglobulin >5 mmol/L and better survival for patients achieving CR+VGPR.
  
  
  CONCLUSIONS
  The overall data highlight the relevance of therapy with new drugs in intracranial myeloma, providing a framework for future clinical trials.
authors.affiliation: Division of Hematology, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy. gozzetti@unisi.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gozzetti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Cerase
authors.forename: Flavia
authors.initials: F
authors.lastname: Lotti
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.forename: Antonio
authors.initials: A
authors.lastname: Palumbo
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Petrucci
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Chiara
authors.initials: C
authors.lastname: Nozzoli
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.forename: Massimo
authors.initials: M
authors.lastname: Offidani
authors.forename: Michele
authors.initials: M
authors.lastname: Floridia
authors.forename: Salvatore
authors.initials: S
authors.lastname: Berretta
authors.forename: Roberto
authors.initials: R
authors.lastname: Vallone
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Elena
authors.initials: E
authors.lastname: Marchini
authors.forename: Alberto
authors.initials: A
authors.lastname: Fabbri
authors.forename: Stefania
authors.initials: S
authors.lastname: Oliva
authors.forename: Elena
authors.initials: E
authors.lastname: Zamagni
authors.forename: Fabiana Gentillini
authors.initials: FG
authors.lastname: Sapienza
authors.forename: Stelvio
authors.initials: S
authors.lastname: Ballanti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mele
authors.forename: Monica
authors.initials: M
authors.lastname: Galli
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Pirrotta
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D015999:Multivariate Analysis; D012189:Retrospective Studies