Diagnosis and management of MM with CNS involvement

A review on the diagnosis and management of central nervous system (CNS) involvement in multiple myeloma (MM) was published in the Journal of the National Comprehensive Cancer Network by D’Angelo et al.

Key data: Suspected CNS involvement in MM should be evaluated using gadolinium-enhanced magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis; MRI detects leptomeningeal and/or parenchymal disease in approximately 90% of cases and CSF sampling is confirmatory in >87%; parenchymal biopsy is rarely required. Management should be individualized and multimodal, using intrathecal chemotherapy or focal radiotherapy as bridging therapy before CNS‑penetrant systemic treatment. Immunomodulatory drugs (IMiDs) may be effective in patients without prior exposure or refractoriness, while selinexor- or venetoclax-based approaches may be considered in selected patients. Patients with CNS responses may be considered for consolidative chimeric antigen receptor (CAR) T‑cell or bispecific antibody therapy.

Key learning: CNS involvement in MM requires prompt MRI- and CSF-based assessment and an individualized, multimodal treatment approach incorporating CNS‑penetrating systemic therapies.