Abstract Details

Title Central Nervous System Involvement in Multiple Myeloma Patients in the Era of Novel Therapies

Topic Neuro-oncology

Presentation(s) P07 - (-)

Poster/Presentation
Number 005

Objective

Background BACKGROUND: CNS-MM is very rare and historically has been associated with a poor prognosis. However, nearly all published reports of CNS-MM are before the widespread use of proteasome inhibitors and immunomodulatory agents. These novel therapies improved the myeloma treatment landscape; increasing overall survival (OS) by 50% and making myeloma a chronic disease for some.

Design/Methods DESIGN/METHODS: From February 1998 to June 2012, we retrospectively identified 9 CNS-MM cases in our tertiary care center. Diagnosis required neuroimaging findings of parenchymal brain lesions, cranial nerve or leptomeningeal enhancement or diagnostic cerebrospinal fluid.

Results RESULTS: All but one patient received thalidomide or lenalidomide, bortezomib, and dexamethasone prior to the diagnosis of CNS-MM. Seven underwent stem cell transplantation. Four had cytogenetic abnormalities indicative of poor prognosis including chromosome 1q gain and translocation (4;14). CNS-MM disease detection occurred a median of 19 months (range 5-58) after myeloma diagnosis. Common neurological symptoms included paresthesia (n=6), vision changes (n=5), confusion (n=3), and seizure (n=2). CNS directed therapies included intrathecal chemotherapy (n=4), whole brain radiation (n=3), involved field radiation (n=3), and high dose methotrexate therapy (n=1). Three patients received multiple therapies. Median OS was 3 months (range 1-12) after CNS-MM diagnosis. Four patients remain alive after 24.5 months of follow up.

Conclusions CONCLUSIONS: This represents the largest case series of CNS-MM in the era of novel therapies, where patients with high risk molecular findings are at increased risk of developing CNS involvement. Molecular findings of adverse prognosis were seen in 4/9 of patients. The prognosis of patients with CNS-MM remains dismal and highlights the need for more research to improve these outcomes.

Authors/Disclosures
Nazanin K. Majd, MD PRESENTER	No disclosure on file
Alexis Demopoulos, MD (Hartford Healthcare)	Dr. Demopoulos has received publishing royalties from a publication relating to health care.
	No disclosure on file
	No disclosure on file

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