Outcome of Patients With Central Nervous System Multiple Myeloma (CNS-MM) Treated With CNS-Directed Radiation Therapy.
| Title: | Outcome of Patients With Central Nervous System Multiple Myeloma (CNS-MM) Treated With CNS-Directed Radiation Therapy. |
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| Authors: | Manzar GS; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.; Dudzinski SO; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Yoder AK; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Seo A; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Nasr LF; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Rafei H; Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX.; Becnel MR; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Patel KK; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Lee HC; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Kaufman GP; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Gaballa MM; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Ye JC; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Saini N; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Thomas SK; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.; Amini B; Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX.; Orlowski RZ; Department of Lymphoma-Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX.; Dabaja BS; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Pinnix CC; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Gunther JR; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Wu SY; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.; Fang PQ; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: pfang@mdanderson.org. |
| Source: | Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2025 Apr; Vol. 25 (4), pp. 271-284. Date of Electronic Publication: 2024 Nov 22. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 101525386 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2152-2669 (Electronic) Linking ISSN: 21522669 NLM ISO Abbreviation: Clin Lymphoma Myeloma Leuk Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2011-: [New York] : Elsevier; Original Publication: Dallas, Tex. : Cancer Media Group |
| MeSH Terms: | Multiple Myeloma*/radiotherapy ; Multiple Myeloma*/mortality ; Multiple Myeloma*/pathology ; Central Nervous System Neoplasms*/radiotherapy ; Central Nervous System Neoplasms*/mortality ; Central Nervous System Neoplasms*/pathology; Humans ; Male ; Female ; Middle Aged ; Aged ; Retrospective Studies ; Adult ; Treatment Outcome ; Aged, 80 and over ; Prognosis |
| Abstract: | Background: The prognosis of multiple myeloma involving the central nervous system (CNS-MM) is poor. We report outcomes of CNS-MM treated with CNS-directed radiation therapy (RT).; Methods: We retrospectively reviewed patients with CNS-MM treated with CNS-directed RT from 2015 to 2024. CNS-MM was defined as having radiographic leptomeningeal or parenchymal disease, and/or pathologic CSF involvement. Complete response (CR) constituted having no atypical cells in CSF or resolution of radiographic disease. Otherwise, patients were categorized with partial response (PR) based on imaging, or stable disease (SD). The Kaplan-Meier method was used to estimate survival.; Results: Of 45 patients with CNS-MM, 28 (62.2%) had high-risk disease. Median overall survival (OS) was 3.7 months (range: 0.4-52.2) postdiagnosis of CNS-MM. Most patients (n = 22, 48.9%) underwent craniospinal irradiation; 9 received whole brain RT (20%), and the others received focal brain or spine RT. The median dose was 20 Gy (2-30 Gy) in 10 fractions (1-15). Due to death or discharge to hospice before further follow-up of treatment efficacy (n = 24), only 21 patients (46.7%) were evaluable post-RT with adequate CSF or radiographic follow-up. For these evaluable patients, post-RT CR occurred in 14 patients (66.7%), PR in 5 (23.8%), and SD in 2 (9.5%). For patients with CR after RT, the median OS was 7.3 months (3-52.2) from CNS-MM diagnosis. Focal brain CNS-MM associated with improved OS and likelihood of attaining long-term survival with CNS CR.; Conclusion: Aggressive multimodality therapy including RT may induce durable CNS control in a small subset of patients with CNS-MM, a high-risk population.; (Copyright © 2024 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Disclosure All reported conflicts are outside the submitted work. GSM reports a patent for induced pluripotent stem cell-derived pancreatic beta cells, previous grants from ReproCell, Inc. and the AAI, and other work is supported by grants from the Radiological Society of North America / Canon Medical Systems (RSNA), an American Society for Radiation Oncology (ASTRO Residents/Fellows in Radiation Oncology Biology Seed Grant), and the American Society of Clinical Oncology (ASCO). |
| Contributed Indexing: | Keywords: CSI; Craniospinal irradiation; Extramedullary multiple myeloma; Leptomeningeal disease; RT |
| Entry Date(s): | Date Created: 20241221 Date Completed: 20250428 Latest Revision: 20260422 |
| Update Code: | 20260422 |
| DOI: | 10.1016/j.clml.2024.11.010 |
| PMID: | 39709251 |
| Database: | MEDLINE |
Journal Article