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Meningeal and cerebral involvement in multiple myeloma patients
F Patriarca1, F Zaja, F Silvestri
1Division of Hematology and Department of Bone Marrow Transplantation, Udine University Hospital, P.le S. Maria della Misericordia, 33100 Udine, Italy. Ematologia@uniud.it
Abstract:
Cerebral involvement is an unusual complication in multiple myeloma: herein four patients who presented myelomatous meningitis with multiple intraparenchymal lesions or a localized cerebral plasmacytoma are described. Two of these patients relapsed with meningeal involvement and a very limited disease outside the central nervous system after an initial complete remission obtained with induction chemotherapy. In the other two cases, the cerebral tumor appeared during first-line treatment. Cytological examination of the cerebrospinal fluid and magnetic resonance were essential for diagnosis. Different modalities of treatment were used, including intrathecal chemotherapy, cranial irradiation, and systemic chemotherapy with high-dose methotrexate and cytarabine, achieving improvement of neurological symptoms in three of four patients.
Insights
Cerebral involvement in multiple myeloma is rare, presenting as myelomatous meningitis or plasmacytoma. Early diagnosis via CSF cytology and MRI, followed by tailored treatments, can improve neurological outcomes.
Area of Science:
- Neurology
- Oncology
- Hematology
Background:
- Multiple myeloma, a plasma cell malignancy, rarely involves the central nervous system.
- Cerebral involvement presents as myelomatous meningitis or localized cerebral plasmacytoma.
Observation:
- Four patients with multiple myeloma and cerebral involvement were described.
- Two patients relapsed with meningeal disease post-chemotherapy; two developed cerebral tumors during initial treatment.
Findings:
- Cerebrospinal fluid cytology and MRI are crucial for diagnosing CNS involvement.
- Treatment modalities included intrathecal chemotherapy, cranial irradiation, and systemic chemotherapy.
- Neurological symptom improvement was observed in three out of four patients.
Implications:
- Highlights the importance of considering CNS involvement in multiple myeloma.
- Suggests that prompt diagnosis and multimodal therapy can improve patient outcomes.
- Underscores the need for vigilance regarding rare neurological complications in multiple myeloma.