melphalan and Spinal-Neoplasms

We report a 48-year-old man, a farmer, presenting with chronic sensori-motor polyneuropathy. Electrophysiology revealed demyelinating type of neuropathy. Immunoelectrophoresis for monoclonal protein was negative; however, plasmacytoma was discovered on spine imaging. After receiving radiotherapy and chemotherapy over past 9 months there has been a considerable improvement in patient's disability. This case highlights the role of skeletal survey in evaluation of chronic demyelinating neuropathy.

Topics: Antineoplastic Combined Chemotherapy Protocols; Dexamethasone; Humans; Male; Melphalan; Middle Aged; Plasmacytoma; POEMS Syndrome; Radiography; Spinal Neoplasms

ANZCCSG BabyBrain99 is a trial of intensive systemic chemotherapy with dual stem cell supported treatment, second look surgery and involved field radiation for children less than four years of age with malignant central nervous system tumours.. Following primary resection, treatment included two courses of cisplatin and oral etoposide, a third course of mobilising chemotherapy (vincristine, etoposide, cyclophosphamide) with stem cell harvest, followed by intensive stem cell supported chemotherapy with high dose cyclophosphamide, etoposide and vincristine. Children were evaluated for second resection before proceeding to a second stem cell supported consolidation therapy consisting of melphalan and carboplatin. Patients then received involved field radiation therapy.. Thirty three children with a range of diagnoses were enrolled. Nine percent of children had metastatic disease at diagnosis. Eighteen children completed treatment including irradiation. At the end of induction the event free survival was 70% (54-86). Forty eight percent of children had a complete response, 18% had stable disease and 3% had a partial response. Five year overall survival was 40% (22-56) and event free survival was 33% (17-50). Children in whom a complete resection were achieved had a significantly superior outcome compared to those children without a complete resection, 5 year EFS 60% (45-75), as compared to 22% (13-30), P-value <0.05.. BabyBrain99 confirms that intensive stem cell supported chemotherapy can be safely administered to infants with CNS tumours however overall prognosis remains poor. Importantly, the study reinforces a complete surgical resection as an important favourable prognostic indicator. Pediatr Blood Cancer 2011;56:1055-1061. © 2011 Wiley-Liss, Inc.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carboplatin; Child, Preschool; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Etoposide; Feasibility Studies; Female; Follow-Up Studies; Glioma; Humans; Infant; Male; Melphalan; Radiotherapy Dosage; Remission Induction; Second-Look Surgery; Spinal Neoplasms; Stem Cell Transplantation; Survival Rate; Transplantation, Autologous; Treatment Outcome; Vincristine

Percutaneous vertebroplasty (PVP) of the axis is a challenging procedure which may be performed by a percutaneous or a transoral approach. There are few reports of PVP at the C2 level. We report a case of unstable C2 fracture treated with the percutaneous approach. The fracture was the first manifestation of multiple myeloma in a previously healthy 47-year-old woman. After local radiotherapy and chemotherapy, the fracture was still unstable and the patient had been continuously wearing a stiff cervical collar for 9 months. Complication-free PVP resulted in pain relief and stabilization and use of the cervical collar could be discontinued. At 18 months follow-up the patient remained free from pain, the fracture was stable and she had returned to work. The purpose of this article is to present the technical facts and to highlight the benefits and potential complications of the procedure. The technical characteristics of the procedure, the indication and results of the present case are discussed together with previously reported cases of PVP treatment at C2.

Topics: Axis, Cervical Vertebra; Bone Cements; Female; Fluoroscopy; Humans; Magnetic Resonance Imaging; Melphalan; Middle Aged; Monitoring, Intraoperative; Multiple Myeloma; Myeloablative Agonists; Neck Pain; Radiotherapy; Spinal Fractures; Spinal Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Vertebroplasty

Solitary plasmacytoma (SP) of the bone is a rare plasma-cell neoplasm. There are no conclusive data in the literature on the optimal radiation therapy (RT) dose in SP. Therefore, in this large retrospective study, we wanted to assess the outcome, prognostic factors, and the optimal RT dose in patients with SP.. Data from 206 patients with bone SP without evidence of multiple myeloma (MM) were collected. Histopathological diagnosis was obtained for all patients. The majority (n = 169) of the patients received RT alone; 32 chemotherapy and RT, and 5 surgery. Median follow-up was 54 months (7-245).. Five-year overall survival, disease-free survival (DFS), and local control was 70%, 46%, and 88%; respectively. Median time to MM development was 21 months (2-135) with a 5-year probability of 51%. In multivariate analyses, favorable factors were younger age and tumor size < 5 cm for survival; younger age for DFS; anatomic localization (vertebra vs. other) for local control. Older age was the only predictor for MM. There was no dose-response relationship for doses 30 Gy or higher, even for larger tumors.. Younger patients, especially those with vertebral localization have the best outcome when treated with moderate-dose RT. Progression to MM remains the main problem. Further investigation should focus on adjuvant chemotherapy and/or novel therapeutic agents.

Topics: Actuarial Analysis; Adult; Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Chemotherapy, Adjuvant; Cohort Studies; Combined Modality Therapy; Dexamethasone; Disease Progression; Disease-Free Survival; Dose-Response Relationship, Radiation; Doxorubicin; Europe; Female; Follow-Up Studies; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; North America; Plasmacytoma; Prednisone; Prognosis; Proportional Hazards Models; Radiotherapy Dosage; Retrospective Studies; Spinal Neoplasms; Treatment Outcome; Vincristine

Nodular regenerative hyperplasia (NRH) of the liver is an infrequent entity that is usually diagnosed after the appearance of clinical signs of portal hypertension such as hepatomegaly, splenomegaly or upper gastrointestinal bleeding due to esophageal varices, which are the most frequently found clinical manifestations in NRH. Ascites is a less frequent finding and has always been described in association with other manifestations of portal hypertension. We describe a new case of NRH with atypical presentation in which ascites was the sole clinical manifestation.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Ascites; Bronchopneumonia; Combined Modality Therapy; Disease Progression; Fatal Outcome; Focal Nodular Hyperplasia; Humans; Hypertension, Portal; Liver Regeneration; Lumbar Vertebrae; Male; Melphalan; Multiple Myeloma; Plasmacytoma; Prednisone; Spinal Neoplasms

A 46-year-old-man received high dose chemotherapy and an autologous stem-cell transplant for multiple plasmacytoma. He had a prolonged period of pancytopenia post-transplantation, which was thought to be due to a suboptimal dose of transplanted stem cells in combination with the effects of interferon therapy and an altered bone marrow microenvironment. Twenty-eight months after the transplant he was found to be hyperthyroid. Anti-thyroid therapy has led to a sustained improvement in his pancytopenia.

Topics: Antineoplastic Agents, Alkylating; Antineoplastic Combined Chemotherapy Protocols; Back Pain; Carbimazole; Cyclophosphamide; Doxorubicin; Graves Disease; Gynecomastia; Humans; Male; Melphalan; Methylprednisolone; Middle Aged; Multiple Myeloma; Pancytopenia; Peripheral Blood Stem Cell Transplantation; Ribs; Spinal Neoplasms; Thoracic Vertebrae; Transplantation Conditioning; Transplantation, Autologous; Vincristine

We report eight patients with a solitary plasmacytoma of the spine associated with neurological complications. The patients included five men and three women with an average age at presentation of 59 years (range, 47 to 73 years). The tumour was confined to the thoracic spine in six cases, cervical spine in one and lumbar spine in one. Duration of symptoms ranged from 2.5 to 22 months. Treatment consisted of a combination of radiotherapy, melphalan and surgery. One patient progressed to multiple myeloma 7 years after surgery. Surgical treatment (anterior surgery in three cases and posterior surgery in five) produced neurological improvement in all patients. We stress the importance of an early diagnosis followed by appropriate treatment including surgery for this clinical entity and long-term follow-up to detect a disseminated disease.

Topics: Aged; Antineoplastic Agents, Alkylating; Cervical Vertebrae; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Melphalan; Middle Aged; Multiple Myeloma; Neurologic Examination; Peripheral Nervous System Diseases; Plasmacytoma; Radiography; Radiotherapy; Spinal Neoplasms; Survival Rate; Thoracic Vertebrae; Treatment Outcome

We report in a 40 year-old woman a bifocal mammary and vertebral plasmocytoma attended by surgery and "preventive" chemotherapy. Eight years later, an acute and apparently non secondary myeloblastic leukemia is observed without sign of diffuse myelomatosis. Plasma cell tumors of the breast are uncommon. Eleven cases have been published, combining solitary plasmocytoma and infiltration occurring in multiple myeloma.

Topics: Adult; Breast Neoplasms; Female; Humans; Leukemia, Myeloid, Acute; Melphalan; Neoplasms, Multiple Primary; Plasmacytoma; Spinal Neoplasms; Time Factors

A unique case of a 15-year-old boy with complete paraplegia due to the compression of osteogenic sarcoma at the fourth thoracic vertebra is presented. Because of the difficulty of surgical treatment, he was treated merely by the arterial infusion of Adriamycin (doxorubicin) and systemic chemotherapy in conformity with the cyclophosphamide, Oncovin (vincristine), methotrexate, phenylalanine mustard, Adriamycin (doxorubicin) ( COMPADRI )-III regimen. The patient regained normal function, and has been disease-free without any neurologic deficit for 6 years. There appears to be some hope for cure using chemotherapy only in otherwise unpromising patients.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Doxorubicin; Humans; Male; Melphalan; Methotrexate; Osteosarcoma; Spinal Neoplasms; Thoracic Vertebrae; Vincristine

Topics: Adult; Bence Jones Protein; beta 2-Microglobulin; Bone Neoplasms; Fanconi Syndrome; Female; Humans; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Lumbar Vertebrae; Melphalan; Neoplasm Metastasis; Plasmacytoma; Prednisone; Radiotherapy Dosage; Spinal Neoplasms; Vincristine

Topics: Adenocarcinoma; Aged; Anemia, Sideroblastic; Cecal Neoplasms; Female; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Radioisotope Teletherapy; Spinal Neoplasms; Thrombocythemia, Essential

Topics: Adult; Diagnosis, Differential; Female; Humans; Laminectomy; Male; Melphalan; Middle Aged; Plasmacytoma; Prognosis; Spinal Diseases; Spinal Neoplasms

Topics: Beta-Globulins; Blood Protein Disorders; Blood Protein Electrophoresis; Clavicle; Drug Therapy; gamma-Globulins; Geriatrics; Immunoglobulin G; Melphalan; Multiple Myeloma; Myelography; Neoplasms; Radiography; Spinal Neoplasms