melphalan and Paraparesis

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.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Cell Differentiation; Combined Modality Therapy; Dexamethasone; Diphosphonates; Doxorubicin; Fatal Outcome; Female; Hematopoietic Stem Cell Transplantation; Humans; Immunologic Factors; Immunosuppressive Agents; Interleukin-2; Melphalan; Meninges; Methotrexate; Multiple Myeloma; Neoplastic Stem Cells; Osteolysis; Pamidronate; Paraparesis; Recurrence; Salvage Therapy; Seizures; Transplantation Conditioning; Transplantation, Homologous; Vincristine