A Case Report of Leptomeningeal Myelomatosis and Rapid Improvement with Regimen Consisting of Daratumumab, Pomalidomide, Vincristine, Procarbazine, and Dexamethasone

• Main Authors: Jew Win, Kuan, Ling Chai, Sing, Pathmanathan, Rajadurai, Gong Lau, Lee, Joseph, Uchang, Sharifah Noor Akmal, Syed Husain
• Format: Article
• Language: English
• Published: Hindawi Publishing 2022
• Subjects: R Medicine (General); RD Surgery
• Online Access: http://ir.unimas.my/id/eprint/39539/1/A%20Case%20Report%20-%20Copy.pdf; http://ir.unimas.my/id/eprint/39539/; https://www.hindawi.com/journals/crihem/2022/4081971/; https://doi.org/10.1155/2022/4081971

Central nervous system (CNS) involvement in multiple myeloma (MM) (MM-CNS) in the form of leptomeningeal myelomatosis or brain parenchyma plasmacytoma is rare, causing challenges in clinical diagnosis and treatment. We would like to report a case of leptomeningeal myelomatosis and illustrated the challeges. A 61-year-old man was diagnosed with MM with left paravertebral plasmacytoma, R-ISS II with high suspicion of double-hit MM, either biallelic aberrancy of TP53 or del(17p) and IGH aberrancy depending on the denition chosen, treated with lenalidomide-bortezomib-dexamethasone and local radiotherapy, later developed systemic relapse and progression to MM-CNS in the form of leptomeningeal myelomatosis. A modied CNS-based treatment not reported before, consisting of daratumumab, pomalidomide, vincristine, procarbazine, and dexamethasone, brought a rapid clinical improvement and warrants a further study. Incorporation of intrathecal thiotepa into the regimen would likely increase the e�cacy.