TY - JOUR A2 - Ribrag, Vincent AU - Bergantim, Rui AU - Bastos, Juliana AU - Soares, Maria José AU - Carvalho, Bruno AU - Soares, Pedro AU - Marques, Cristina AU - Costa, Jennifer AU - Guimarães, José Eduardo AU - Trigo, Fernanda PY - 2020 DA - 2020/01/04 TI - Aggressive Central Nervous System Relapse after Autologous Stem Cell Transplant in Multiple Myeloma: Case Reports and Literature Review SP - 8563098 VL - 2020 AB - Extramedullary disease is an aggressive presentation at diagnosis and relapse for multiple myeloma (MM) patients. Central nervous system (CNS) is a very rare manifestation of the extramedullary disease, accounting for less than 1% of MM on diagnosis and relapse. Neurological symptoms are unspecific and usually attributed to other causes. We present two patients with CNS-MM at relapse after autologous stem cell transplant highlighting the importance of clinical suspicion and interdisciplinarity at diagnostic workup as well as the need for intensive therapeutic options on such rare and aggressive cases. The presence of neurological abnormalities in anamnesis and physical examination on a patient with MM should always prompt to suspect of a CNS involvement, and active investigation must be undertaken. MRI is the standard radiological method to detect CNS-MM, with histopathological corroboration by stereotactic biopsy and CSF evaluation alongside. Treatment of CNS-MM should include two essential approaches—be able to cross the BBB and treat the systemic disease. There is no standard therapy for this extramedullary relapse, and a tailored and multiple therapy should be promptly started—intrathecal therapy, radiotherapy, and systemic therapy, including an immunomodulator. SN - 2090-6560 UR - https://doi.org/10.1155/2020/8563098 DO - 10.1155/2020/8563098 JF - Case Reports in Hematology PB - Hindawi KW - ER -