Central nervous system involvement by multiple myeloma: A multi-institutional retrospective study of 172 patients in daily clinical practice

Artur Jurczyszyn, Norbert Grzasko, Alessandro Gozzetti, Jacek Czepiel, Alfonso Cerase, Vania Hungria, Edvan Crusoe, Ana Luiza Miranda Silva Dias, Ravi Vij, Mark A. Fiala, Jo Caers, Leo Rasche, Ajay K. Nooka, Sagar Lonial, David H. Vesole, Sandhya Philip, Shane Gangatharan, Agnieszka Druzd-Sitek, Jan Walewski, Alessandro CorsoFederica Cocito, Marie Christine M Vekemans, Erden Atilla, Meral Beksac, Xavier Leleu, Julio Davila, Ashraf Badros, Ekta Aneja, Niels Abildgaard, Efstathios Kastritis, Dorotea Fantl, Natalia Schutz, Tomas Pika, Aleksandra Butrym, Magdalena Olszewska-Szopa, Lidia Usnarska-Zubkiewicz, Saad Z. Usmani, Hareth Nahi, Chor S. Chim, Chaim Shustik, Krzysztof Madry, Suzanne Lentzsch, Alina Swiderska, Grzegorz Helbig, Renata Guzicka-Kazimierczak, Nikoletta Lendvai, Anders Waage, Kristian T. Andersen, Hirokazu Murakami, Sonja Zweegman, Jorge J. Castillo

Research output: Contribution to journalArticle

Abstract

The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22%) were diagnosed with CNS involvement at the time of initial MM diagnosis and 134 (78%) at relapse/progression. Upon diagnosis of CNS MM, 97% patients received initial therapy for CNS disease, of which 76% received systemic therapy, 36% radiotherapy and 32% intrathecal therapy. After a median follow-up of 3.5 years, the median overall survival (OS) from the onset of CNS involvement for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively (P<0.001). At least one previous line of therapy for MM before the diagnosis of CNS disease and >1 cytogenetic abnormality detected by FISH 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 (P<0.001). Neurological manifestations, not considered chemotherapy-related, observed at any time after initial diagnosis of MM should raise a suspicion of CNS involvement. Although prognosis is generally poor, the survival of previously untreated patients and patients with favorable cytogenetic profile might be prolonged due to systemic treatment and/or radiotherapy.

Original languageEnglish
Pages (from-to)575-580
Number of pages6
JournalAmerican Journal of Hematology
Volume91
Issue number6
DOIs
Publication statusPublished - Jun 1 2016

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Multiple Myeloma
Central Nervous System
Retrospective Studies
Survival
Radiotherapy
Central Nervous System Diseases
Therapeutics
Neurologic Manifestations
Cytogenetics
Chromosome Aberrations
Multicenter Studies
Multivariate Analysis
Recurrence
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)
  • Hematology

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Central nervous system involvement by multiple myeloma : A multi-institutional retrospective study of 172 patients in daily clinical practice. / Jurczyszyn, Artur; Grzasko, Norbert; Gozzetti, Alessandro; Czepiel, Jacek; Cerase, Alfonso; Hungria, Vania; Crusoe, Edvan; Silva Dias, Ana Luiza Miranda; Vij, Ravi; Fiala, Mark A.; Caers, Jo; Rasche, Leo; Nooka, Ajay K.; Lonial, Sagar; Vesole, David H.; Philip, Sandhya; Gangatharan, Shane; Druzd-Sitek, Agnieszka; Walewski, Jan; Corso, Alessandro; Cocito, Federica; Vekemans, Marie Christine M; Atilla, Erden; Beksac, Meral; Leleu, Xavier; Davila, Julio; Badros, Ashraf; Aneja, Ekta; Abildgaard, Niels; Kastritis, Efstathios; Fantl, Dorotea; Schutz, Natalia; Pika, Tomas; Butrym, Aleksandra; Olszewska-Szopa, Magdalena; Usnarska-Zubkiewicz, Lidia; Usmani, Saad Z.; Nahi, Hareth; Chim, Chor S.; Shustik, Chaim; Madry, Krzysztof; Lentzsch, Suzanne; Swiderska, Alina; Helbig, Grzegorz; Guzicka-Kazimierczak, Renata; Lendvai, Nikoletta; Waage, Anders; Andersen, Kristian T.; Murakami, Hirokazu; Zweegman, Sonja; Castillo, Jorge J.

In: American Journal of Hematology, Vol. 91, No. 6, 01.06.2016, p. 575-580.

Research output: Contribution to journalArticle

Jurczyszyn, A, Grzasko, N, Gozzetti, A, Czepiel, J, Cerase, A, Hungria, V, Crusoe, E, Silva Dias, ALM, Vij, R, Fiala, MA, Caers, J, Rasche, L, Nooka, AK, Lonial, S, Vesole, DH, Philip, S, Gangatharan, S, Druzd-Sitek, A, Walewski, J, Corso, A, Cocito, F, Vekemans, MCM, Atilla, E, Beksac, M, Leleu, X, Davila, J, Badros, A, Aneja, E, Abildgaard, N, Kastritis, E, Fantl, D, Schutz, N, Pika, T, Butrym, A, Olszewska-Szopa, M, Usnarska-Zubkiewicz, L, Usmani, SZ, Nahi, H, Chim, CS, Shustik, C, Madry, K, Lentzsch, S, Swiderska, A, Helbig, G, Guzicka-Kazimierczak, R, Lendvai, N, Waage, A, Andersen, KT, Murakami, H, Zweegman, S & Castillo, JJ 2016, 'Central nervous system involvement by multiple myeloma: A multi-institutional retrospective study of 172 patients in daily clinical practice', American Journal of Hematology, vol. 91, no. 6, pp. 575-580. https://doi.org/10.1002/ajh.24351
Jurczyszyn, Artur ; Grzasko, Norbert ; Gozzetti, Alessandro ; Czepiel, Jacek ; Cerase, Alfonso ; Hungria, Vania ; Crusoe, Edvan ; Silva Dias, Ana Luiza Miranda ; Vij, Ravi ; Fiala, Mark A. ; Caers, Jo ; Rasche, Leo ; Nooka, Ajay K. ; Lonial, Sagar ; Vesole, David H. ; Philip, Sandhya ; Gangatharan, Shane ; Druzd-Sitek, Agnieszka ; Walewski, Jan ; Corso, Alessandro ; Cocito, Federica ; Vekemans, Marie Christine M ; Atilla, Erden ; Beksac, Meral ; Leleu, Xavier ; Davila, Julio ; Badros, Ashraf ; Aneja, Ekta ; Abildgaard, Niels ; Kastritis, Efstathios ; Fantl, Dorotea ; Schutz, Natalia ; Pika, Tomas ; Butrym, Aleksandra ; Olszewska-Szopa, Magdalena ; Usnarska-Zubkiewicz, Lidia ; Usmani, Saad Z. ; Nahi, Hareth ; Chim, Chor S. ; Shustik, Chaim ; Madry, Krzysztof ; Lentzsch, Suzanne ; Swiderska, Alina ; Helbig, Grzegorz ; Guzicka-Kazimierczak, Renata ; Lendvai, Nikoletta ; Waage, Anders ; Andersen, Kristian T. ; Murakami, Hirokazu ; Zweegman, Sonja ; Castillo, Jorge J. / Central nervous system involvement by multiple myeloma : A multi-institutional retrospective study of 172 patients in daily clinical practice. In: American Journal of Hematology. 2016 ; Vol. 91, No. 6. pp. 575-580.
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abstract = "The multicenter retrospective study conducted in 38 centers from 20 countries including 172 adult patients with CNS MM aimed to describe the clinical and pathological characteristics and outcomes of patients with multiple myeloma (MM) involving the central nervous system (CNS). Univariate and multivariate analyses were performed to identify prognostic factors for survival. The median time from MM diagnosis to CNS MM diagnosis was 3 years. Thirty-eight patients (22{\%}) were diagnosed with CNS involvement at the time of initial MM diagnosis and 134 (78{\%}) at relapse/progression. Upon diagnosis of CNS MM, 97{\%} patients received initial therapy for CNS disease, of which 76{\%} received systemic therapy, 36{\%} radiotherapy and 32{\%} intrathecal therapy. After a median follow-up of 3.5 years, the median overall survival (OS) from the onset of CNS involvement for the entire group was 7 months. Untreated and treated patients had median OS of 2 and 8 months, respectively (P<0.001). At least one previous line of therapy for MM before the diagnosis of CNS disease and >1 cytogenetic abnormality detected by FISH 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 (P<0.001). Neurological manifestations, not considered chemotherapy-related, observed at any time after initial diagnosis of MM should raise a suspicion of CNS involvement. Although prognosis is generally poor, the survival of previously untreated patients and patients with favorable cytogenetic profile might be prolonged due to systemic treatment and/or radiotherapy.",
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AU - Jurczyszyn, Artur

AU - Grzasko, Norbert

AU - Gozzetti, Alessandro

AU - Czepiel, Jacek

AU - Cerase, Alfonso

AU - Hungria, Vania

AU - Crusoe, Edvan

AU - Silva Dias, Ana Luiza Miranda

AU - Vij, Ravi

AU - Fiala, Mark A.

AU - Caers, Jo

AU - Rasche, Leo

AU - Nooka, Ajay K.

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AU - Vesole, David H.

AU - Philip, Sandhya

AU - Gangatharan, Shane

AU - Druzd-Sitek, Agnieszka

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AU - Corso, Alessandro

AU - Cocito, Federica

AU - Vekemans, Marie Christine M

AU - Atilla, Erden

AU - Beksac, Meral

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AU - Davila, Julio

AU - Badros, Ashraf

AU - Aneja, Ekta

AU - Abildgaard, Niels

AU - Kastritis, Efstathios

AU - Fantl, Dorotea

AU - Schutz, Natalia

AU - Pika, Tomas

AU - Butrym, Aleksandra

AU - Olszewska-Szopa, Magdalena

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AU - Usmani, Saad Z.

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AU - Chim, Chor S.

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AU - Madry, Krzysztof

AU - Lentzsch, Suzanne

AU - Swiderska, Alina

AU - Helbig, Grzegorz

AU - Guzicka-Kazimierczak, Renata

AU - Lendvai, Nikoletta

AU - Waage, Anders

AU - Andersen, Kristian T.

AU - Murakami, Hirokazu

AU - Zweegman, Sonja

AU - Castillo, Jorge J.

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