Rare Case of Refractory Multiple Myeloma With Dura Mater Involvement
Posted: Monday, July 1, 2019
A case study published in OncoTargets and Therapy featured a patient with refractory multiple myeloma who experienced dura mater involvement. Disease progression to this part of the brain and spinal cord is rare in multiple myeloma, occurring in up to 1% of cases. And in this case, the 49-year-old woman responded to lenalidomide treatment, according to Yafei Wang, MD, of the Tianjin Medical University Hospital in China, and colleagues.
The patient initially presented with right rib pain lasting 4 months. A positron-emission tomography–computed tomography scan revealed a soft-tissue mass on the right fifth rib. The laboratory findings revealed an immunoglobulin D (IgD)-lambda type of monoclonal immunoglobulin, and bone marrow biopsy showed 80% lambda-restricted, CD138 and CD38 double-positive plasma cells. The patient was then diagnosed with IgD-lambda multiple myeloma. She underwent two cycles of bortezomib/doxorubicin/dexamethasone (PAD), after which she achieved a partial response and continued PAD treatment for two additional cycles.
After treatment, she reported escalating jaw numbness and mild dysphagia. Magnetic resonance imaging (MRI) showed a thickening of dura mater and an increased strength of signal. The researchers noted, “Flow cytometry of the bone marrow showed 2.22% lambda-restricted, CD138- and CD38-positive plasma cells.”
The patient began an aggressive treatment regimen intended to cross the blood-brain barrier, receiving 25 mg of lenalidomide on days 1 to 21; 500 mg of cyclophosphamide on days 1, 8, 15, and 21; and 30 mg of dexamethasone on days 1 to 4 and 12 to 15. After a single cycle of this treatment, all symptoms were eradicated, the patient’s platelet count returned to normal, and the serum-free lambda light chain value decreased to 51.6 mg/L (from 267.5 mg/L after induction treatment). A follow-up MRI showed a significant decrease in both dura mater masses and signal strength.
Disclosure: The study authors reported no conflicts of interest.