Isolated relapse of plasma cell leukemia in the central nervous systems: a case report and literature review.
Takafumi OboKen MoritaYutaro SumidaKumi Nakazaki-WatadaniMasako IkemuraKoichiro YasakaOsamu AbeHirokazu TakamiShunsaku TakayanagiShota TanakaHiroaki MakiYosuke MasamotoAkiyoshi MiwaMineo KurokawaPublished in: International journal of hematology (2023)
Plasma cell leukemia is a rare yet aggressive form of multiple myeloma characterized by high levels of plasma cells circulating in the peripheral blood. We recently experienced a case of plasma cell leukemia that had been in stringent complete remission for nine years after autologous stem cell transplantations with subsequent courses of lenalidomide maintenance therapy, and then relapsed as an extramedullary plasmacytoma in the central nervous system. Assessment of the bone marrow did not prove proliferation of plasma cells at relapse, but imbalanced elevation of serum levels of free light chains was observed without changes in other clinical biomarkers including immunoglobulin levels. Salvage chemotherapy with isatuximab, pomalidomide, and dexamethasone (IsaPD) was promptly initiated. After two courses of IsaPD, significant remission was achieved and the neuronal symptoms completely resolved. When excessive serum levels of clonotypic free light chains are noted, their significance should be carefully assessed even when plasma cell propagation in the bone marrow is not observed. In such cases, hematologists should search for extramedullary proliferation of plasma cells, including in the immune-privileged central nervous system.
Keyphrases
- bone marrow
- multiple myeloma
- cell therapy
- induced apoptosis
- single cell
- stem cells
- acute myeloid leukemia
- cell cycle arrest
- signaling pathway
- peripheral blood
- mesenchymal stem cells
- acute lymphoblastic leukemia
- squamous cell carcinoma
- high dose
- cell death
- rheumatoid arthritis
- depressive symptoms
- disease activity
- endoplasmic reticulum stress
- diffuse large b cell lymphoma
- cell proliferation
- physical activity
- sleep quality
- weight gain
- pi k akt
- hodgkin lymphoma
- chronic lymphocytic leukemia
- free survival
- locally advanced