CENTRAL-NERVOUS-SYSTEM RELAPSES AFTER AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR MYELOMA - REPORT OF 2 CASES

We report on two cases of central nervous system (CNS) relapse after h igh-dose chemotherapy and autologous stem cell transplantation. A 55-y ear-old man received two courses of vincristin, doxorubicin and dexame thasone (VAD) Bs an induction treatment for stage IIIB IgG kappa multi ple myeloma. Bone marrow stem cell collection was performed after a hi gh-dose melphalan (HDM) course (140 mg/m(2)). Autologous bone marrow t ransplantation (ABMT) was performed with this cryo-preserved unpurged bone marrow sample after a second HDM course. Three months after ABMT, the patient presented with signs of central nervous involvement with plasma cells and monoclonal IgG kappa in the cerebral fluid. The patie nt died despite systemic and intrathecal chemotherapy. A 50-year-old m an was initially treated with 3 courses of VAD for a stage IIIA IgD la mbda multiple myeloma. Blood stem cell were collected after a course o f high-dose etoposide and cyclophosphamide. ABMT was performed after t otal body irradiation (TBI) and HDM. Three months later, he presented with right leg palsy and a lumbar puncture showed numerous plasma cell s and the presence of the IgG lambda. The patient died of neurological complications three months later. Extramedullary occurred prior to me dullary relapse in the two cases, suggesting the presence of an extram edullary clone of plasma cells with a high degree of chemo-resistance. Although high-dose chemotherapy appears promising, this therapeutic a pproach could allow the occurrence of presently unobserved complicatio ns. Wether CNS prophylaxis is indicated in this context, as recommende d in leukemia, remains an open question.