Central nervous system involvement by multiple myeloma: A multi-institutional retrospective study of 172 patients in daily clinical practice

• Type of Material: Article
• Authors: Artur Jurczyszyn, Jagiellonian University; Norbert Grzasko, Medical University of Lublin; Alessandro Gozzetti, Azienda Ospedaliera Universitaria Senese; Jacek Czepiel, Jagiellonian University; Alfonso Cerase, Azienda Ospedaliera Universitaria Senese; Vania Hungria, Santa Casa Medical School; Edvan Crusoe, Santa Casa Medical School; Ana Luiza Miranda Silva Dias, Santa Casa Medical School; Ravi Vij, Washington University; Mark A. Fiala, Washington University; Jo Caers, Centre Hospitalier Universitaire de Liege; Leo Rasche, University Hospital Wuerzburg; Ajay Nooka, Emory University; Sagar Lonial, Emory University; David H. Vesole, Hackensack UMC; Sandhya Philip, Hackensack UMC; Shane Gangatharan, Fremantle Hosp; Agnieszka Druzd-Sitek, Maria Sklodowska-Curie Institute; Jan Walewski, Maria Sklodowska-Curie Institute; Alessandro Corso, University of Pavia; Federica Cocito, University of Pavia; Marie-Christine M. Vekemans, Cliniques Universitaires Saint-Luc; Erden Atilla, Ankara University; Meral Beksac, Ankara University; Xavier Leleu, Hospital Huriez
• Language: English
• Date: 2016-06-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/ajh.24351
• Title of Journal or Parent Work: American Journal of Hematology
• ISSN: 0361-8609
• Volume: 91
• Issue: 6
• Start Page: 575
• End Page: 580
• Keywords: Science & Technology; CHROMOSOMAL-ABNORMALITIES; Life Sciences & Biomedicine; OF-THE-LITERATURE; BENDAMUSTINE; MANIFESTATIONS; MENINGEAL MYELOMA; AGENTS; ASSOCIATION; INVASION; INTRATHECAL CHEMOTHERAPY; THALIDOMIDE; Hematology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Oncology

Abstract

The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22%) were diagnosed with CNS involvement at the time of initial MM diagnosis and 134 (78%) at relapse/progression. Upon diagnosis of CNS MM, 97% patients received initial therapy for CNS disease, of which 76% received systemic therapy, 36% radiotherapy and 32% intrathecal therapy. After a median follow-up of 3.5 years, the median overall survival (OS) from the onset of CNS involvement for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively (P<0.001). At least one previous line of therapy for MM before the diagnosis of CNS disease and >1 cytogenetic abnormality detected by FISH were independently associated with worse OS. The median OS for patients with 0, 1 and 2 of these risk factors were 25 months, 5.5 months and 2 months, respectively (P<0.001). Neurological manifestations, not considered chemotherapy-related, observed at any time after initial diagnosis of MM should raise a suspicion of CNS involvement. Although prognosis is generally poor, the survival of previously untreated patients and patients with favorable cytogenetic profile might be prolonged due to systemic treatment and/or radiotherapy.