Journal List > Korean J Hematol > v.43(3) > 1032786

Yun, Song, Jin, Yang, Park, Lee, Yun, Kim, and Jo: A Case of Central Nervous System Myelomatosis Developing after Allogeneic Hematopoietic Stem Cell Transplantation

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 peripheralblood stem cell transplantation using a reduced-intensity conditioning regimen consisting of melphalan, fludarabine, and antithymocyte globulin. Two months after the transplant, she developed a moderatemotor 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.

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Fig. 1
A brain MR image showing a soft tissue mass in the left pterygopalatine fossa (arrow).
kjh-43-194f1.tif
Fig. 2
Spine T1-weighted MR images showing subtle diffuse leptomeningeal enhancement of thoracic spine (small arrows in the right figure).
kjh-43-194f2.tif
Fig. 3
Cyto-centrifuge preparation of cerebrospinal fluid showing atypical plasma cells (Papanicolau stain, ×400).
kjh-43-194f3.tif
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