Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Effective treatment of leptomeningeal multiple myeloma with total craniospinal irradiation supported by second allogeneic donor stem cell infusion

Bone Marrow Transplantation volume 35, pages 423–424 (2005)Cite this article

Leptomeningeal infiltration is a rare complication of multiple myeloma (MM) that portends an extremely poor prognosis. The true incidence is unknown with few literature reports. We report a case of leptomeningeal relapse of MM post allogeneic stem cell transplant (alloSCT), which was successfully treated with a single dose of intrathecal methotrexate and total craniospinal irradiation (CSI) supported by second allogeneic donor stem cell infusion (SCI). To our knowledge, this is the first report of a second allogeneic SCI for this condition. We postulate that a graft-versus-myeloma (GVM) effect may be playing an important role in sustaining the response and conclude that CSI followed by a second allogeneic SCI is an appropriate treatment option in patients with leptomeningeal myelomatosis in the setting of prior alloSCT. The donor SCI may serve to enhance haematopoiesis recovery as well as inducing a GVM effect.

This man was 42 years old when diagnosed with stage III myeloma, presenting as kappa light chain Bence Jones Protein (BJP) and diffuse skeletal disease. He achieved a partial response (PR) following local radiotherapy (RT) and 8 months of intermittent melphalan and prednisolone, then proceeded to a matched-sibling alloSCT with busulphan and cyclophosphamide conditioning. Subsequent graft-versus-host disease (GVHD), manifested by deranged liver function, oral ulcers and diarrhoea, required 3 years of low-dose immunosuppression that was successfully discontinued. After a 4-year disease-free interval, he developed diffuse lytic bone disease, BJP of 0.17 g/l and a 4 cm extramedullary gastrocnemius plasmacytoma. Bone marrow demonstrated 25% plasmacytosis. Following treatment for 8 weeks on an escalating dose of thalidomide to 800 mg on a phase II clinical trial,1 the plasmacytoma reduced to <2 cm and marrow infiltration to 5%. After 11 months of stable disease on Thalidomide and Interferon, multiple relapses occurred with proteinuria, bony disease and soft tissue scalp plasmacytomas, which were stabilized at different times with local RT, VAD chemotherapy, and weekly cyclophosphamide (500 mg) with daily prednisolone over the following 2.5 years. He then presented with 4 weeks of bilateral leg weakness that progressed to an inability to weight bear, associated with worsening diplopia on upward and right sided gaze. Marked bilateral proximal leg weakness with normal knee and ankle reflexes were also evident.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Mileshkin L, Biagi JJ, Mitchell P et al. Multicenter phase 2 trial of thalidomide in relapsed/refractory multiple myeloma: adverse prognostic impact of advanced age. Blood 2003; 102: 69–77.

    Article  CAS  Google Scholar 

  2. Oda K, Egawa H, Okuhara T et al. Meningeal involvement in Bence Jones multiple myeloma. Cancer 1991; 67: 1900–1902.

    Article  CAS  Google Scholar 

  3. Magdolna S, Dileep K, Samir A . Meningeal myeloma with cord compression. Am J Clin Oncol 2001; 19: 3991–3993.

    Article  Google Scholar 

  4. Vicari P, Ribas C, Sampaio M et al. Can thalidomide be effective to treat plasma cell leptomeningeal infiltration. Eur J Haematol 2003; 70: 198.

    Article  Google Scholar 

  5. Schulman P, Sun T, Sharer L et al. Meningeal involvement in IgD myeloma with cerebrospinal fluid paraprotein analysis. Cancer 1980; 46: 152–155.

    Article  CAS  Google Scholar 

  6. Fassas A, Mulwalla F, Berryman T et al. Myeloma of the central nervous system: association with high risk chromosomal abnormalities, plasmablastic morphology and extramedullary manifestations. Br J Haematol 2002; 117: 103.

    Article  Google Scholar 

  7. Peterson S, Wagner A, Gimsing P . Cerebral and meningeal multiple myeloma after autologus stem cell transplantation. A case report and review of the literature. Am J Hematol 1999; 62: 228–233.

    Article  Google Scholar 

  8. Leifer D, Grabowski T, Simonian N et al. Leptomeningeal myelomatosis presenting with mental status changes and other neurologic findings. Cancer 1992; 70: 1889–1904.

    Article  Google Scholar 

  9. Tricot G, Vesole D, Jagannath S et al. Graft-versus-myeloma effect: proof of principle. Blood 1996; 87: 1196–1198.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Haematology Service, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia

    H Quach

  2. Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia

    G Ryan

  3. Frankston Hospital, Victoria, Australia

    V Ganju

  4. Haematology Service, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, Victoria, 8006, Australia

    H M Prince

Authors
  1. H Quach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V Ganju
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H M Prince
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quach, H., Ryan, G., Ganju, V. et al. Effective treatment of leptomeningeal multiple myeloma with total craniospinal irradiation supported by second allogeneic donor stem cell infusion. Bone Marrow Transplant 35, 423–424 (2005). https://doi.org/10.1038/sj.bmt.1704777

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704777

Search

Advanced search

Quick links