Novel Agents in CNS Myeloma Treatment
Alessandro Gozzetti and Alfonso Cerase
Affiliation: Hematology, Azienda Ospedaliera Universitaria Senese, Policlinico “Santa Maria alle Scotte”, Viale Bracci 16, 53100 Siena, Italy.
Keywords: Bortezomib, chemotherapy, CNS, extramedullary myeloma, IMID’s, new agents.
Central nervous system localization of multiple myeloma (CNS-MM) accounts for about 1% of all MM.
Treatment is still unsatisfactory. Many treatments have been described in the literature: chemotherapy (CHT), intrathecal
therapy (IT), and radiotherapy (RT), with survivals reported between one month and six months. Recent drugs such as the
immunomodulatory drugs (IMiDs) and proteasome inhibitors (bortezomib) have changed the treatment of patients with
MM, both younger and older, with a significant improvement in response and survival. The activity of new drugs in CNSMM
has been reported but is still not well known. Bortezomib does not cross the blood brain barrier (BBB), and IMID’s
seem to have only a minimal crossover. The role of novel agents in CNS MM management will be discussed as well as
the potential role of other new immunomodulatory drugs (pomalidomide) and proteasome inhibitors that seem to cross the
BBB and hold promise into the treatment of this rare and still incurable localization of the disease.
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