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CSF myelin basic protein levels in leptomeningeal metastases. Relationship to disease activity
Abstract:
Myelin basic protein (MBP) was serially measured in 177 CSF samples of 33 patients with leptomeningeal metastases and in 34 cancer controls. The mean level in cancer controls (free of neural involvement) was 5.7 +/- 0.33 ng/ml (normal less than 5 ng/ml) with abnormal elevation of MBP detected in 17%. The activity of the leptomeningeal disease was classified as either acute-progressive, stable or in remission on the basis of clinical and CSF cytological findings. CSF MBP levels were analysed in each stage. Abnormal elevation of MBP was detected in 74% of the 68 samples obtained in the acute-progressive stage (mean +/- SEM: 18.25 +/- 1.4 ng/ml, P less than 0.0001), in 24% of the 79 samples in the stable phase (mean: 7.99 +/- 0.8 ng/ml, NS) and in 20% of the 30 samples in remission (mean 5.7 +/- 0.3 ng/ml, NS). Similar changes in levels of CSF MBP were also observed in longitudinal studies of patients responding to treatment or relapsing to the acute stage. Eight patients developed treatment induced necrotizing leukoencephalopathy with typical CT-scan findings; elevated levels of CSF MBP were detected in 7 of them (mean: 21 +/- 3 ng/ml) when measured within 2 weeks of diagnosis but not when measured 2 months earlier. Our study suggests that in leptomeningeal metastases, CSF MBP levels are indicators of the disease activity, particularly if longitudinal determinations are used.
Insights
Cerebrospinal fluid myelin basic protein (MBP) levels indicate leptomeningeal metastases activity. Elevated MBP in CSF suggests active disease, especially when monitored over time.
Area of Science:
- Neuroscience
- Oncology
- Biochemistry
Background:
- Leptomeningeal metastases (LM) are a serious complication of cancer.
- Accurate monitoring of LM activity is crucial for patient management.
- Cerebrospinal fluid (CSF) biomarkers can aid in diagnosing and monitoring neurological conditions.
Purpose of the Study:
- To investigate the utility of myelin basic protein (MBP) levels in CSF as an indicator of leptomeningeal metastases activity.
- To correlate CSF MBP levels with different stages of leptomeningeal disease and treatment response.
Main Methods:
- Serial measurement of CSF MBP in patients with leptomeningeal metastases and cancer controls.
- Classification of leptomeningeal disease activity into acute-progressive, stable, and remission stages.
- Analysis of CSF MBP levels in relation to disease stage, treatment, and development of necrotizing leukoencephalopathy.
Main Results:
- Elevated CSF MBP levels were detected in 17% of cancer controls.
- Abnormal MBP elevation was significantly higher in the acute-progressive stage (74%) compared to stable (24%) or remission (20%) stages.
- CSF MBP levels correlated with disease activity, showing increases during relapse and decreases during remission.
- Elevated MBP was observed in 7 out of 8 patients with treatment-induced necrotizing leukoencephalopathy.
Conclusions:
- CSF MBP levels serve as a valuable indicator of leptomeningeal metastases activity.
- Longitudinal monitoring of CSF MBP is particularly useful for tracking disease progression and response to treatment.
- MBP may also be a marker for treatment-related neurological complications like necrotizing leukoencephalopathy.