Yellu Mahender R, Engel Jessica M, Ghose Abhimanyu, Onitilo Adedayo A
Division of Hematology/Oncology, Stem Cell Transplantation, University of Cincinnati, Cincinnati, OH, USA.
Marshfield Clinic Cancer Care at St. Michaels, Stevens Point, WI, USA.
Hematol Oncol. 2016 Mar;34(1):2-8. doi: 10.1002/hon.2185. Epub 2014 Dec 19.
Neurological complications related to multiple myeloma (MM) are not uncommon; however, direct involvement of the central nervous system (CNS) is extremely rare and represents a diagnostic and therapeutic challenge. Significant survival difference has been noted with the introduction of novel therapy in patients with MM, but their effect on the incidence and their use for management of leptomeningeal myeloma (LMM) is uncertain. Analysis of published data demonstrates its recent increased incidence, median time to CNS presentation, and slight improvement in median survival after diagnosis of LMM. Less common MM isotypes have been overrepresented in LMM. CNS relapse occurred mostly in patients with Durie-Salmon stage III MM. Despite treatments, standard or experimental, the survival rates of LMM remain dismal. Monitoring high risk patients closely, even after achieving complete remission, may be useful in early detection of LMM. As we gain better understanding of LMM, we recommend that future research and clinical care focus on earlier diagnosis and development of more efficient CNS-directed therapy to improve survival in this patient population.
与多发性骨髓瘤（MM）相关的神经系统并发症并不罕见；然而，中枢神经系统（CNS）的直接受累极为罕见，是一个诊断和治疗难题。随着新型疗法应用于MM患者，已观察到显著的生存差异，但它们对柔脑膜骨髓瘤（LMM）发病率的影响以及用于LMM治疗的效果尚不确定。对已发表数据的分析表明，LMM的发病率近期有所上升，出现中枢神经系统症状的中位时间以及LMM诊断后中位生存期略有改善。LMM中较少见的MM亚型比例过高。CNS复发大多发生在Durie-Salmon III期MM患者中。尽管采用了标准或实验性治疗，LMM的生存率仍然很低。密切监测高危患者，即使在达到完全缓解后，可能有助于早期发现LMM。随着我们对LMM有了更好的理解，我们建议未来的研究和临床护理应侧重于早期诊断以及开发更有效的中枢神经系统定向治疗方法，以提高该患者群体的生存率。
