title: Overview of recent trends in diagnosis and management of leptomeningeal multiple myeloma.
abstract: Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM. Less common MM isotypes have been overrepresented in LMM. CNS relapse occurred mostly in patients with Durie-Salmon stage III MM. Despite treatments, standard or experimental, the survival rates of LMM remain dismal. Monitoring high risk patients closely, even after achieving complete remission, may be useful in early detection of LMM. As we gain better understanding of LMM, we recommend that future research and clinical care focus on earlier diagnosis and development of more efficient CNS-directed therapy to improve survival in this patient population.
authors.affiliation: Division of Hematology/Oncology, Stem Cell Transplantation, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Mahender R
authors.initials: MR
authors.lastname: Yellu
authors.affiliation: Marshfield Clinic Cancer Care at St. Michaels, Stevens Point, WI, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Engel
authors.affiliation: Division of Hematology/Oncology, Stem Cell Transplantation, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Ghose
authors.affiliation: Marshfield Clinic Weston Center, Department of Hematology/Oncology, Weston, WI, USA.
authors.forename: Adedayo A
authors.initials: AA
authors.lastname: Onitilo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002869:Chromosome Aberrations; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D019468:Disease Management; D055088:Early Detection of Cancer; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D008297:Male; D008495:Medical Oncology / Q000379:methods / Q000639:trends*; D008578:Meninges / Q000473:pathology*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D009194:Myeloma Proteins / Q000032:analysis; D059906:Neuroimaging; D011379:Prognosis; D013129:Spinal Puncture; D063189:Symptom Assessment
chemical_list: D009194:Myeloma Proteins
keywords: central nervous system; metastasis; multiple myeloma