New antimyeloma drugs in spinal cord infiltration for multiple myeloma. Determination of lenalidomide in cerebrospinal fluid with ultrasensitive high-performance liquid chromatography
A 64-year-old woman with IgA kappa multiple myeloma was treated with thalidomide-dexa- methasone. Due to progression of the disease, bortezomib, doxorubicin and dexamethasone were administered, followed by autologous stem cell transplantation. Although near-complete remission was achieved, 5 months later, neuro- logical symptoms appeared and the patient was diagnosed with multiple myeloma with cells in- filtrating the spinal cord. Bis-chloronitrosourea, bortezomib and lenalidomide were then admin- istered and although the patient remained neu- rologically asymptomatic, she died 3 months later becausee of disease progression. Lena- lidomide entered into the cerebrospinal fluid (confirmed by ultrasensitive high-performance liquid chromatography), although did not im- prove the poor prognosis of multiple myeloma involving the central nervous system.
References
[1]
Fassas, A.B., Muwalla, F., Berryman, T., Benramdane, R., Joseph, L., Anaissie, E., et al. (2002) Myeloma of the central nervous system: Association with high-risk chro- mosomal abnormalities, plasmablastic morphology, and extramedullary manifestations. British Journal of Hae- matology, 117, 103-108.
doi:10.1046/j.1365-2141.2002.03401.x
[2]
Chang, H., Bartlett, S.E., Patterson, B., Chen, I.C. and Long, Y.Q. (2005) The absence of CD56 on malignant plasma cells in the cerebrospinal fluid is the hallmark of multiple myeloma involving central nervous system. Bri- tish Journal of Haematology, 129, 539-541.
doi:10.1111/j.1365-2141.2005.05493.x
[3]
Nieuwenhuizen, L. and Biesma, D.H. (2008) Central nervous system myelomatosis: Review of the literature. European Journal of Haematology, 80, 1-9.
[4]
Tsenova, L., Mangaliso, B., Muller, G., Chen, Y., Freed- man, V.H., Stirling, D., et al. (2002) Use of IMDi3, a tha- lidomide analog, as an adjunct to therapy for experiment- tal tuberculous meningitis. Antimicrobial Agents and Chemo- therapy, 46, 1887-1895.
doi:10.1128/AAC.46.6.1887-1895.2002
[5]
Varettoni, M., Corso, A., Zappasodi, P., Calliada, F., Castagnola, C., Mangiacavalli, S., et al. (2008) Infiltra- tion of the spinal cord in a patient with multiple myeloma. Journal of Clinical Oncology, 26, 4207-4209.
[6]
Dimopoulos, M.A. and Kastritis, E. The role of novel drugs in multiple myeloma. Annals of Oncology, 19, 121- 127. doi:10.1093/annonc/mdn444
[7]
Serefhanoglu, S., Haznedaroglu, I.C., Goker, H., Buyuka- sik, Y. and Ozcebe, O.I. (2009) Multiple bulky cutaneous plasmacytomas with CNS relapse without bone marrow involvement during the course of a lambda light chain myeloma. Onkologie, 32, 662-664.
[8]
Colagrande, M., Di Ianni, M., Ciurnelli, R., Gallucci, M., Mariani, G. and Tabilio, A. (2007) Striking response to intrathecal liposomal cytarabine in a patient with men- ingeal myelomatosis. British Journal of Haematology, 138, 812- 823. doi:10.1111/j.1365-2141.2007.06712.x
[9]
Richardson, P.G., Schlossman, R.L., Weller, E., Hide- shima, T., Mitsiades, C., Davies, F., et al. (2002) Immu- nomodulatory drug CC-5013 overcomes drug resistance and is well tolerated in patients with relapsed multiple myeloma. Blood, 100, 3063-3067.
doi:10.1182/blood-2002-03-0996
[10]
Dahut, W.L., Aragon-Ching, J.B., Woo, S., Tohnya, T.M., Gulley, J.L., Arlen, P.M., et al. (2009) Phase I study of oral lenalidomide in patients with refractory metastatic cancer. The Journal of Clinical Pharmacology, 49, 650- 660. doi:10.1177/0091270009335001
