Case Study of Intracerebral Recurrence of Plasmablastic Myeloma with Achievement of Complete Response after Treatment with Lenalidomide
Bibliographic record
Abstract
We describe an unusual case of multiple myeloma (MM) with plasmablastic morphology in a young man who, after chemotherapy and autologous stem cell transplant, developed disease recurrence with isolated CNS involvement and developed complete remission after treatment with lenalidomide. Plasmablastic type is characterized by immature cells with round nuclei and prominent central nucleoli. According to different studies, plasmablastic MM may account for 15-30% of MM cases and tend to be associated with adverse prognosis. It has been shown to correlate with high proliferation rate, extensive bone marrow infiltration, but not with high risk chromosomal aberrations. Despite the fact that plasmablastic morphology is not uncommon in MM patients, CNS is involved in less than 1% of patients with MM. In 82% of patients with CNS myelomatosis, neoplastic plasma cells were found in CSF; and, in those without CSF involvement, diagnosis was established by MRI which detected either leptomeningeal or intraparenchymal involvement. It is worth mentioning that CNS involvement in MM tends to occur in younger patients, without evidence of advanced disease, sometime with isolated CNS involvement. In many of these patients, complete remission can be achieved with combined treatment which includes systemic chemotherapy, radiation treatment, as well as novel immunomodulating agents. CNS myelomatosis must be suspected whenever patient with MM develops neurologic symptoms not related to chemotherapy treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".