Abstract
Progressive multiple myeloma may manifest features of 'de-differentiation', including a plasmablastic appearance, failure to secrete paraprotein, extramedullary involvement, and resistance to treatment. A 44-year-old woman with kappa-light chain myeloma underwent allogeneic stem cell transplantation (SCT). Twenty months later she developed paraspinal plasmablastic myeloma in the absence of paraprotein in urine or myeloma in the marrow. The paraspinal masses responded to chemotherapy. At 30 months she developed myelomatous meningitis, which proved resistant to intrathecal chemotherapy, irradiation, and donor lymphocyte infusion (DLI). The leptomeningeal disease led to death at 38 months. This is the first report of leptomeningeal relapse of myeloma after allografting.
MeSH terms
-
Adult
-
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
-
Cell Differentiation
-
Combined Modality Therapy
-
Dexamethasone / administration & dosage
-
Diphosphonates / therapeutic use
-
Doxorubicin / administration & dosage
-
Fatal Outcome
-
Female
-
Hematopoietic Stem Cell Transplantation*
-
Humans
-
Immunologic Factors / therapeutic use
-
Immunosuppressive Agents / therapeutic use
-
Interleukin-2 / therapeutic use
-
Melphalan / administration & dosage
-
Meninges / pathology*
-
Methotrexate / therapeutic use
-
Multiple Myeloma / drug therapy
-
Multiple Myeloma / pathology*
-
Multiple Myeloma / therapy
-
Neoplastic Stem Cells / pathology
-
Osteolysis / drug therapy
-
Osteolysis / etiology
-
Pamidronate
-
Paraparesis / etiology
-
Recurrence
-
Salvage Therapy
-
Seizures / etiology
-
Transplantation Conditioning
-
Transplantation, Homologous*
-
Vincristine / administration & dosage
Substances
-
Diphosphonates
-
Immunologic Factors
-
Immunosuppressive Agents
-
Interleukin-2
-
Vincristine
-
Dexamethasone
-
Doxorubicin
-
Pamidronate
-
Melphalan
-
Methotrexate