Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Figures & data

Figure 1. Cerebrospinal fluid (CSF) cytological examination showed presence of abnormal plasma cells featuring enlarged and hyperchromatic nuclei, nuclear contour irregularity and occasional cells with binucleation. (Giemsa stain, original magnification, x 400).

Figure 2. Flow cytometric analysis of the CSF specimen demonstrating plasma cells (PC). The PC are of intermediate side scatter and are CD45 positive (A), CD 38 brightly positive, CD 19 negative and CD 138 positive (B and C). They are also dimly positive for CD 28 and are CD 27 negative (D); this is a feature of aberrant PC. (Van Dongen et al Leukemia 2012).

Table 1. Treatment and outcomes of CNS-MM in the era of NAs.

References	Number of patients	Initial Treatment	Time to CNS involvement	CNS treatment	OS	ASCT % (pre/post)
Chen CI et al, 2013 ^6	37	54% NA: (16% PI, 38% IMID) 46% HDT	20.6 mo	70% NA: (51% IMID, 19% PI). 81% IT 78% CSI 27% DTPACE	4.6 mo	46%/5%
Paludo J et al, 2013 ^25	26		24 mo	42% NA: (23% PtdIns, 19% IMID). 31% CSI 19% ITC	3 mo	/23%
Erini K et al, 2015 ^18	31 (29 received treatment for CNS-MM)	100% NA (74% PI, 11% IMID, 16% both)	29 mo	62% NA: (41% PI, 17% IMID, 3.5% both PI+IMID). 27.5% SC 10% ITC 34% SC+ITC	3 mo	3.5%
Nazanin M et al, 2015 ^17	9 (7 received treatment)	100% PtdIns89% IMID	12.7 mo	77% NA: (55% PI, 22% IMID). 78% SC 67% CSI 67% ITC 11% MTX	3.5 mo	55%/33%
Gangatharan SA et al, 2012 ^26	7	86% IMID (T) 57% PI (B)	24 mo	100% CSI86% SC71% ITC	2 mo	100%/
Lee D et al, 2013 ^27	17	82% NA (T,L) 47% PtdIns (B)	36 mo	41% NA: [29% IMID (T),12% PI (B)]. 71% CSI 47% ITC 18% SC	4 mo	100%/0%
Nieuwenhuizen L et al, 2007 ^19	109		17.8 mo	51% ITC 45% SC 43% CSI	2 mo	/22%

Legend: CNS = Central Nervous System; OS = Overall Survival; ITC = Intra-Thecal Chemotherapy; CSI = Cranio-Spinal Irradiation; SC = Systemic Chemotherapy; BEAM = [BCNU (carmustine), Etoposide, Ara-C (cytarabine), Melphalan]; NA = Novel agents; DTPACE = Dexamethasone, Thalidomide, Cisplatin, Doxorubicin, Etoposide; ASCT = Autologous Stem cell transplant; B = Bortezomib; T = Thalidomide; L = Lenalidomide; MTX = Methotrexate; IMID = Immunomodulatory Agents; PtdIns = Proteasome Inhibitor.

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