MULTIPLI MIJELOM SA DISEMINACIJOM U CENTRALNI NERVNI SISTEM – PRIKAZ SERIJE SLUČAJA
Sažetak
Uvod: Multipli mijelom sa diseminacijom u centralni nervni sistem (CNS-MM) predstavlja veoma redak entitet koji čini manje od 1% ekstramedularnih multiplih mijeloma, a manifestuje se spektrom neuroloških deficita. Modaliteti lečenja mogu biti lokalni, uključujući intratekalnu hemioterapiju i radioterapiju, kao i sistemski, uključujući autolognu/alogenu transplantaciju matičnih ćelija hematopoeze (ATMĆH).
Cilj: Prikazujemo iskustvo našeg centra u lečenju ovog retkog entiteta.
Prikaz bolesnika: Kod prve pacijentkinje sa dijagnozom multiplog mijeloma BJ lambda CS IIIA R-ISS 2, verifikovana je tumorska masa u bazi lobanje sa destrukcijom desne sfenoidne i temporalne kosti, koja se manifestovala paralizom n. facialis-a. Pacijentkinja je lečena po CVD (ciklofosfamid, bortezomib, deksametazon) protokolu sa postignutom parcijalnom remisijom, tumorska promena je palijativno ozračena, potom je sprovedena autologna transplantacija matičnih ćelija hematopoeze. Lečenje je nastavljeno po DaraRd (daratumumab, lenalidomid, deksametazon) protokolu sa ciljem sprovođenja druge autologne transplantacije matičnih ćelija hematopoeze po produbljivanju remisije. Dosadašnje ukupno preživljavanje iznosi 20 meseci. Kod druge pacijentkinje sa dijagnozom multiplog mijeloma BJ kappa CS IIIA ISS 2, diseminacija u CNS se desila u prvom relapsu bolesti. Sprovedena je zračna terapija endokranijuma, potom je ordinirano sedam ciklusa po PAD (bortezomib, doksorubicin, deksametazon) protokolu sa efektom progresije bolesti i kasnije smrtnim ishodom. Ukupno preživljavanje iznosilo je 48 meseci; preživljavanje od dijagnostikovanja infiltracije CNS-a je bilo 25 meseci.
Zaključak: Uprkos napretku u dijagnostici i lečenju, prognoza za CNS-MM ostaje loša zbog kompleksnog i agresivnog kliničkog ponašanja, a zbog niske incidencije i ograničenosti podataka, postoji potreba za daljim studijama sa ovom malom grupom pacijenata.
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