Table 5.
Treatment outcomes in studies of patients with CNS involvement.
| Reference Study type | No. of patients | Time period covered | Treatments | PFS | OS |
|---|---|---|---|---|---|
|
Bommer et al. [49] Retrospective |
16 (all LMM) | 2005–2016 | Intrathecal chemotherapy, radiotherapy | – |
Median OS: 82 days (after LMM diagnosis) |
|
Jurczyszyn et al. [48] Retrospective |
172 (38 at initial MM diagnosis, 134 at relapse/progression) |
1995–2014 |
Systemic therapy (n = 117) Radiotherapy (n = 56) Intrathecal therapy (n = 49) Steroids only (n = 5) Mass resection (n = 1) SCT (n = 32) |
– |
Median OS: 6.7 months (all patients) 2 months (untreated patients) 8 months (treated patients) |
|
Paludo et al. [50] Retrospective |
29 (7 at initial diagnosis of MM, 22 at relapse) | 1998–2014 |
Radiation therapy (n = 22) + adjuvant intrathecal chemotherapy (n = 6) Intrathecal + systemic therapy (n = 1) Systemic therapy (n = 2) Novel agents, including bortezomib (28%), thalidomide (14%), lenalidomide (10%), and pomalidomide (3%), administered after CNS involvement. ASCT after the diagnosis of CNS disease (24%) |
Median OS (95% CI): CNS involvement, 40 months (24–56) Control (no CNS involvement), 93 months (67–129) Patients with ASCT after CNS involvement, 19 months (10–67) |
|
|
Katodritou et al. [51] Retrospective |
31 | 2000–2013 |
Bortezomib-based (n = 12) IMiD-based (n = 5) Chemotherapy alone (n = 8) Intrathecal infusions (n = 3) Additional radiotherapy (n = 9) |
Median (95% CI) CNS involvement, 16 months (2–30.6) Control (no CNS involvement), 36 months (12–60) p = 0.004 |
Median (95% CI) CNS involvement, 47 months (32–62) Control (no CNS involvement), 84 months (31–137) p = 0.01 |
|
Abdallah et al. [52] Retrospective |
35 | 1996–2012 |
Chemotherapy, including intrathecal (n = 28) Intrathecal alone (n = 3) |
– | Median (range): 4 months (1–13) |
|
Chen et al. [53] Retrospective |
37 | 1999–2010 |
Intrathecal chemotherapy (81%) Cranial and/or spinal irradiation (78%) IMiDs (51%) Cisplatin-based (27%) Bortezomib (19%) Alkylators (11%) Dexamethasone alone (8%) ASCT (5%) |
Median (95% CI) after CNS involvement: 3.1 months (2.0–6.0) | Median (95% CI) after CNS involvement: 4.6 months (2.8–6.7) |
|
Lee et al. [54] Retrospective |
17 | 2000–2011 |
Systemic pharmacotherapy Intrathecal chemotherapy and/or radiotherapy |
– | Median (range) after CNS involvement: 4 months (1–23) |
| Gozzetti et al. [55] | 12 | 2000–2010 |
Systemic treatment Systemic treatment + radiotherapy Systemic + radiotherapy + intrathecal Radiotherapy + intrathecal Intrathecal (note: specific treatments received by patients with CNS-MM not specified) |
– | Median (range): 6 months (1–23) |
ASCT autologous stem cell transplantation, CNS central nervous system, IMiD immunomodulatory drug, LMM leptomeningeal myelomatosis, MM multiple myeloma.