Central Nervous System Involvement by Multiple Myeloma:A Multi-Institutional Retrospective Study of 172 Patients
| Autor: | N. Grz ko, Alessandro Gozzetti, Jorge J. Castillo, Lidia Usnarska-Zubkiewicz, Suzanne Lentzsch, Chor S. Chim, Grzegorz Helbig, Jo Caers, Alfonso Cerase, Aleksander B. Skotnicki, Ekta Aneja, Chaim Shustik, V. Hungria, Magdalena Olszewska-Szopa, Marie-Christiane Vekemans, Sonja Zweegman, Xavier Leleu, Agnieszka Druzd-Sitek, Artur Jurczyszyn, Alessandro Corso, Shane A Gangatharan, K. M. Dry, Ajay K. Nooka, Eftathios Kastritis, Mark A. Fiala, Federica Cocito, Meral Beksac, A. L. Silva, S. Philip, Ravi Vij, Leo Rasche, Tomas Pika, Ruben Niesvizky, David H. Vesole, Sagar Lonial, Julio Dávila, Niels Abildgaard, A. Widerska, Hirokazu Murakami, Hareth Nahi, Edvan de Queiroz Crusoe, Erden Atilla, Ashraf Z. Badros, Kristian Thidemann Andersen, N. Lendvain, Renata Guzicka-Kazimierczak, Saad Z. Usmani, Aleksandra Butrym, Jan Walewski, Dorotea Fantl, Natalia Schutz, Anders Waage |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Cancer Research
medicine.medical_specialty business.industry human *multiple myeloma *retrospective study *patient *myeloma *workshop *central nervous system diagnosis therapy survival radiotherapy systemic therapy case study headache radiculopathy patient history of chemotherapy prognosis flow cytometry intrathecal drug administration Europe case report Asia cerebrospinal fluid cytology multivariate analysis risk factor follow up imaging spine adult brain seizure dizziness peripheral neuropathy South America Australia cerebrospinal fluid nuclear magnetic resonance imaging Retrospective cohort study Hematology medicine.disease Oncology Health care medicine Physical therapy Intensive care medicine business Multiple myeloma |
| Zdroj: | Jurczyszyn, A, Gozzetti, A, Cerase, A, Hungria, V, Crusoe, E, Silva, A L, Vij, R, Fiala, M A, Caers, J, Rasche, L, Nooka, A K, Lonial, S, Vesole, D H, Philip, S, Gangatharan, S, Druzd-Sitek, A, Walewski, J, Corso, A, Cocito, F, Vekemans, M C M, Atilla, E, Beksac, M, Leleu, X, Davila, J, Badros, A, Niesvizky, R, Aneja, E, Abildgaard, N, Kastritis, E, Fantl, D, Schutz, N, Pika, T, Olszewska-Szopa, M, Butrym, A, Usnarska-Zubkiewicz, L, Grz ko, N, Usmani, S, Nahi, H, Chim, C S, Shustik, C, Dry, K M, Lentzsch, S, Widerska, A, Helbig, G, Guzicka-Kazimierczak, R, Lendvain, N, Waage, A, Andersen, K T, Murakami, H, Zweegman, S, Skotnicki, A B & Castillo, J J 2015, ' Central Nervous System Involvement by Multiple Myeloma : A Multi-Institutional Retrospective Study of 172 Patients ', Clinical Lymphoma, Myeloma & Leukemia, vol. 15, no. S3, pp. e128-e129 . https://doi.org/10.1016/j.clml.2015.07.322 |
| DOI: | 10.1016/j.clml.2015.07.322 |
| Popis: | Introduction: Central nervous system (CNS) involvement by multiple myeloma (MM) is a rare occurrence and is found in approximately 1% of MM patients at some time during the course of their disease. At the time of diagnosis, extramedullary MM is found in 7% of patients, and another 6% may develop this condition at more advanced stages. However, most of the available data arises from case reports and small case series. The objective of this study is to describe the clinicopathological characteristics and outcomes of patients with MM involving the CNS. Patients and Methods: The multicenter retrospective study conducted in 38 centers from 20 countries in Europe, Asia, Australia, North and South America included a total of 172 adult patients with CNS MM. Patients' characteristics are presented descriptively. Univariate and multivariate analyses were performed to identify prognostic factors for survival. Results: The median time from MM diagnosis to CNS MM diagnosis was 3 years. Upon diagnosis, 97% patients with CNS MM received frontline therapy, of which 76% received systemic therapy, 36% radiotherapy and 32% intrathecal therapy. The most common symptoms at presentation were visual changes (36%), radiculopathy (27%), headache (25%), confusion (21%), peripheral neuropathy (9%), dizziness (7%) and seizures (6%). MRI of the brain and/or spine were performed in 156 patients (91%), and showed evidence of disease in 145 (93%). After a median follow-up of 3.5 years, the median OS for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively. At least one previous line of therapy for MM and > 1 cytogenetic abnormality 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. Conclusion: Neurological manifestations observed in patients with MM should raise a suspicion of CNS involvement. The diagnosis of CNS MM should be based on imaging studies and CSF cytology and flow cytometry. Although prognosis is generally poor, especially in patients with a long history of chemotherapy and unfavorable cytogenetic profile, survival of individuals free from these negative prognostic factors can be prolonged due to administration of systemic treatment and/or radiotherapy. Prospective multi-institutional studies are warranted to improve the outcome of patients with CNS MM. |
| Databáze: | OpenAIRE |
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