Korean J Hematol.  2008 Sep;43(3):194-197. 10.5045/kjh.2008.43.3.194.

A Case of Central Nervous System Myelomatosis Developing after Allogeneic Hematopoietic Stem Cell Transplantation

• Yun GW
• Song IC
• Jin SA
• Yang YJ
• Park NH
• Lee HJ
• Yun HJ
• Kim S
• Jo DY

• KMID: 2252189
• DOI: http://doi.org/10.5045/kjh.2008.43.3.194

Abstract

Central nervous system (CNS) myelomatosis, which is the presence of monoclonal plasma cells in the cerebrospinal fluid (CSF), is extremely rare. We report a case of CNS myelomatosis developed in a 45-year-old woman with multiple myeloma in complete response, which was achieved by allogeneic peripheral blood stem cell transplantation using a reduced-intensity conditioning regimen consisting of melphalan, fludarabine, and antithymocyte globulin. Two months after the transplant, she developed a moderate motor and sensory weakness in both lower extremities. Atypical plasma cells were found in the CSF, and immunofixation revealed monoclonal light chain in the CSF. She was given three courses of weekly intra-thecal chemotherapy consisting of methotrexate, cytarabine, and dexamethasone, which cleared the CSF. This case indicates that the allogeneic transplantation could not control CNS myelomatosis, despite successfully treating the bone marrow myeloma.

Keyword

Multiple myeloma; CNS myelomatosis; Allogeneic stem cell transplantation; Intra-thecal chemotherapy

MeSH Terms

Antilymphocyte Serum
Bone Marrow
Central Nervous System
Cytarabine
Dexamethasone
Female
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Light
Lower Extremity
Melphalan
Methotrexate
Middle Aged
Multiple Myeloma
Nervous System
Peripheral Blood Stem Cell Transplantation
Plasma Cells
Transplantation, Homologous
Transplants
Vidarabine
Antilymphocyte Serum
Cytarabine
Dexamethasone
Melphalan
Methotrexate
Vidarabine

Figure

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  Fig. 1 A brain MR image showing a soft tissue mass in the left pterygopalatine fossa (arrow).

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  Fig. 2 Spine T1-weighted MR images showing subtle diffuse leptomeningeal enhancement of thoracic spine (small arrows in the right figure).

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  Fig. 3 Cyto-centrifuge preparation of cerebrospinal fluid showing atypical plasma cells (Papanicolau stain, ×400).

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