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Here we present an unusual case of an aggressive relapse of Multiple Myeloma (MM), with both central nervous system (CNS) and pericardial involvement, appearing within 4 months’ post-transplant. This case was documented in Case Reports in Oncology in July 2017 by Jonathan Pan and colleagues from the Department of Medical Oncology, Thomas Jefferson Hospital, Philadelphia, PA, USA.
This is an unusual presentation of extremely rapidly progressing MM. BM biopsy and SPEP results indicated minimal disease burden immediately after HSCT. The authors could not find any similar cases previously reported in the literature, suggesting that such rapid CNS involvement is extremely rare. In general, CNS involvement occurs in relapsed patients predominantly as leptomeningeal disease. However, alterations of chromosome 13 and 17, and translocation 4;14 have been associated with a higher risk of extramedullary myeloma, as well as elevated lactate dehydrogenase (LDH) levels and IgA or IgD myeloma subtypes. In this case the patient had an IgG subtype, but raised LDH, chromosome 13 deletion and translocation 4;14. Histological examination of the plasmacytoma also displayed Ki-67 positivity, which has been linked to extraosseous relapse of MM. However, cardiac involvement was unusual and unexpected.
This rare case highlights the need to carefully monitor relapse and to be mindful of high-risk indicators. With a trend towards precision medicine and tailored regimens, clearer genetic and biochemical indicators are emerging that will enable more effective stratification of risk and prognosis, and are likely to be incorporated into early diagnostic work-ups.
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