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Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old fema...

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Autores principales: Abid, Muhammad Bilal, De Mel, Sanjay, Abid, Muhammad Abbas, Tan, Kong Bing, Chng, Wee Joo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970536/
https://www.ncbi.nlm.nih.gov/pubmed/27105248
http://dx.doi.org/10.1080/15384047.2016.1178427
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author Abid, Muhammad Bilal
De Mel, Sanjay
Abid, Muhammad Abbas
Tan, Kong Bing
Chng, Wee Joo
author_facet Abid, Muhammad Bilal
De Mel, Sanjay
Abid, Muhammad Abbas
Tan, Kong Bing
Chng, Wee Joo
author_sort Abid, Muhammad Bilal
collection PubMed
description Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration.
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spelling pubmed-49705362016-08-26 Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence Abid, Muhammad Bilal De Mel, Sanjay Abid, Muhammad Abbas Tan, Kong Bing Chng, Wee Joo Cancer Biol Ther Bedside to Bench Report Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration. Taylor & Francis 2016-04-22 /pmc/articles/PMC4970536/ /pubmed/27105248 http://dx.doi.org/10.1080/15384047.2016.1178427 Text en © 2016 The Author(s). Published with license by Taylor & Francis Group, LLC http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.
spellingShingle Bedside to Bench Report
Abid, Muhammad Bilal
De Mel, Sanjay
Abid, Muhammad Abbas
Tan, Kong Bing
Chng, Wee Joo
Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title_full Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title_fullStr Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title_full_unstemmed Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title_short Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence
title_sort bortezomib-related neuropathy may mask cns relapse in multiple myeloma: a call for diligence
topic Bedside to Bench Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970536/
https://www.ncbi.nlm.nih.gov/pubmed/27105248
http://dx.doi.org/10.1080/15384047.2016.1178427
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