Zajęcie ośrodkowego układu nerwowego w przebiegu szpiczaka plazmocytowego – opis przypadku i przegląd literatury

Abstract

a c t a h a e m a t o l o g i c a p o l o n i c a 4 6 ( 2 0 1 5 ) 2 4 2 -2 4 7 i n f o r m a c j e o a r t y k u l e Historia artykułu: Słowa kluczowe: szpiczak ośrodkowy układ nerwowy diagnostyka leczenie Słowa kluczowe: Myeloma Central nervous system Diagnosis Treatment a b s t r a c t In multiple myeloma extramedullary involvement occurs in 13% of patients. Central nervous system (CNS) involvement is extremely rare and comprises 1% of cases. Review of literature shows only limited data on this subject and consists mostly of few case reports. Scarce knowledge about CNS involvement in the course of multiple myeloma makes its diagnosis and treatment very difficult and challenging. The authors describe a clinical case which illustrates the problem from a clinician point of view. Furthermore, we analyzed the available data from literature and summarized the current state of knowledge on diagnosis, potential prognostic factors, treatment and prognosis in CNS myeloma involvement.

Isolated Progression of Multiple Myeloma into the Extramedullary Plasmacytoma of Dura Mater: A Case Report and Review of the Literature

“…Crossing of the blood–brain barrier (BBB) by myeloma cells and their growth without engaging the bones or meninges indicates their clonal progression and protects them from the standard agents used for MM treatment, which usually cannot cross the BBB. There is no standard treatment for CNS involvement in MM; however, these patients should receive treatment penetrating CNS ( Table 1 ) [ 27 ]. Although appealing, intrathecal triplet therapy (hydrocortisone, methotrexate, and/or cytarabine) is controversial, since studies show only modest benefit [ 5 , 11 , 18 ].…”

“…Immunomodulatory drugs such as thalidomide, lenalidomide, and especially pomalidomide cross the BBB [ 35 ]. The presence of thalidomide in the cerebrospinal fluid was found during its use [ 27 , 36 ], but the therapeutic effect was visible only after several weeks, which is not feasible in a disease with a more rapid course. Lenalidomide also crosses the blood–brain barrier but penetrates at a very low level of 5% [ 11 , 37 ].…”

“…However, in cases of possible BBB deterioration, such as an infection or neoplastic disease, the possibility of more efficient daratumumab penetration cannot be excluded [ 37 ]. A second auto-HCT might be used as consolidation, as in our case, since melphalan crosses the BBB at high doses [ 9 , 27 , 39 ]. In the study reported by Jurczyszyn et al, 32 patients (21%) received auto- or allo-HCT after the induction phase.…”