去甲二氢愈创木酸对恶性胶质瘤细胞周期的影响

 目的　观察去甲二氢愈创木酸(NDGA)对人恶性胶质瘤细胞系SHG-44细胞周期的影响。方法　采用细胞培养、免疫组化、细胞计数及流式细胞仪检测等技术方法。结果　①在200μM浓度范围内,NDGA对SHG-44细胞增殖有抑制作用,使细胞增殖受阻于G1→S期,且这种作用与浓度呈正相关;②在NDGA处理96小时内,NDGA对SHG-44细胞的增殖抑制作用以处理后24小时最明显;③NDGA处理后,SHG-44细胞cyclin D1和CDK4蛋白表达减弱,p16蛋白表达增强。结论　NDGA对SHG-44细胞周期有明显的增殖抑制作用,且这种作用可能与CDK4蛋白激酶活性降低有关。     

去甲二氢愈创木酸诱导体外恶性胶质瘤细胞凋亡的研究

目的：观察去甲二氢愈创木酸（nordihydroguaiaretic acid,NDGA)对人恶性胶质瘤细胞系SHG-44细胞凋亡的影响,并探讨其发生的可能机理。方法：采用MTT（methy thiazolyl tetrazolium)法检测细胞增殖抑制的情况。利用光镜和电镜观察及TUNEL法检测体外培养细胞的凋亡情况,用免疫组织化学,原位杂交和图像分析等方法检测bcl-2基因mRNA和蛋白的表达水平。结果：（1）一定浓度（100μmol/L）的NDGA处理SHG-44细胞不同时间后,在NDGA抑制细胞增殖的同时,也可诱导此细胞发生凋亡,且随着作用时间的延长,凋亡细胞数增加越明显;（2）免疫组化染色结果表明,一定浓度的NDGA处理细胞不同时间后,出现SHG-44细胞bcl-2蛋白表达水平降低,且随着作用时间的延长,这种趋势更加明显,与细胞凋亡的发生呈负相关;（3）原位杂交结果显示;NDGA处理细胞不同时间后,出现SHG-44细胞bcl-2基因mRNA的表达水平降低,结果与免疫组化检测一致。结论：NDGA可诱导SHG-44细胞的凋亡,这种作用可能与其下调bcl-2基因的表达有关,确切机制有待进一步深入研究。     

miR-21与胶质瘤SHG-44细胞放射敏感性的关系

目的 探讨miR-21与胶质瘤SHG-44细胞放射敏感性的关系及其机制.方法 建立胶质瘤辐射抗性细胞模型SHG-44抗,采用实时定量聚合酶链反应(PCR)法检测SHG-44和SHG-44抗细胞中miR-21的表达.通过反义寡核苷酸序列AS-miR-21敲低SHG-44抗细胞中miR-21的表达,以实时定量PCR验证敲低效果.采用成克隆实验测定miR-21敲低前后SHG-44抗细胞的放射敏感性,通过检测caspase-3的活性评估细胞凋亡.结果 SHG-44抗细胞的miR-21表达量是SHG-44细胞的1.49倍.成克隆实验结果显示,敲低miR-21表达后,SHG-44抗细胞的放射敏感性提高,平均致死剂量和准阈剂量的放射增敏比分别为1.48和1.54.AS-miR-21转染组、单纯放射组及转染联合放射组SHG-44抗细胞的caspase-3表达水平分别为2.24±0.14、2.05±0.19和5.72±0.45,转染联合放射组分别高于AS-miR-21转染组和单纯放射组.结论 miR-21可能参与了胶质瘤辐射抗性的形成,有望成为治疗辐射抗性胶质瘤的潜在靶点.     

人脑胶质瘤细胞SHG-44照射后COX-2表达与放射敏感性的关系

目的:探讨人脑胶质瘤细胞SHG-44照射存活后代细胞对放射敏感性的变化,以及环氧合酶-2(COX-2)的表达情况,为临床使用COX-2抑制剂提供理论依据。方法:采用克隆形成率研究SHG-44及SHG-44照射存活后代细胞的放射敏感性;并分别用RT-PCR方法及免疫组化的方法检测COX-2基因mRNA和蛋白的表达情况。结果:与SHG-44细胞相比,SHG-44照射后代细胞对放射的敏感性下降,COX-2 mRNA及蛋白表达均升高。COX-2表达水平与SHG-44照射后代细胞放射敏感性呈负相关。结论:辐射诱导了SHG-44细胞COX-2表达的升高,使SHG-44照射后代细胞对放射敏感性下降,COX-2表达的升高可能是导致其辐射耐受的原因之一。     

DNA修复基因ERCC1启动子区甲基化与胶质瘤放射敏感性的相关性研究

背景与目的:胶质瘤的放射治疗效果与其放射敏感性密切相关,有许多因素影响着胶质瘤的放射敏感性。研究已经发现某些基因启动子区CpG岛的甲基化会导致基因的表达沉默,从而影响肿瘤放射敏感性。本文初步探讨了DNA修复基因ERCC1启动子区CpG甲基化与脑胶质瘤放射敏感性的关系。方法:培养4种胶质瘤细胞株MGR1、MGR2、SF767、T98G,集落形成实验法检测其放射敏感性,以2Gy照射后细胞存活集落数(SF2)作为标准表示。应用亚硫酸氢钠修饰后测序的方法对4株细胞中ERCC1基因启动子区CpG岛的甲基化状态进行分析。进而分析其甲基化状态与放射敏感性的关系。结果:4种胶质瘤细胞株的放射敏感性存在较大差异,SF2均数范围从0.18到0.70;在ERCC1启动子区CpG为去甲基化状态细胞株的SF2值较高(MGR1,0.59±0.09;T98G,0.70±0.05),表示对放射线较抗拒;ERCC1启动子区CpG为甲基化状态细胞株的SF2值较低(MGR2,0.18±0.05;SF767,0.32±0.08),表示对放射线较敏感(t=-4.43,P<0.05)。结论:ERCC1启动子区CpG甲基化状态可能与胶质瘤细胞株放射敏感性相关,有希望成为预测胶质瘤放疗敏感性的新指标。     

Rab31对神经胶质瘤细胞增殖迁移侵袭的影响及机制研究

目的:研究Rab31对人神经胶质瘤细胞增殖迁移侵袭的影响及相关分子机制。方法:Western blot检测正常人胶质细胞NHA和3株人神经胶质瘤细胞SHG-44、TJ905和LN229中Rab31表达;将3种Rab31沉默siRNA及其对照分别转染至神经胶质瘤SHG-44细胞中,分别记为si-Rab31-1组、si-Rab31-2组、si-Rab31-3组和si-NC组,Western blot验证转染效率,CCK-8法检测细胞增殖,Transwell实验检测细胞迁移侵袭,Western blot检测PI3K/AKT信号通路蛋白PI3K p101、p-AKT和AKT表达水平。结果:与正常人胶质细胞NHA相比,神经胶质瘤细胞SHG-44、TJ905和LN229中Rab31蛋白表达显著增加（P＜0.01）;与si-NC组比较,si-Rab31-1、si-Rab31-2和si-Rab31-3组神经胶质瘤细胞SHG-44中Rab31蛋白表达显著降低（P＜0.01）,其中si-Rab31-2组SHG-44细胞中Rab31表达最低;抑制Rab31表达可显著抑制SHG-44细胞增殖、迁移和侵袭,并抑制SHG-44细胞中PI3K/AKT信号通路转导（P＜0.01）。结论:抑制Rab31可通过抑制PI3K/AKT信号通路转导抑制胶质瘤SHG-44细胞增殖、迁移和侵袭。     

SHG-44胶质瘤干细胞球的表型特点及其移植瘤病理特征

目的 研究SHG-44胶质瘤干细胞球的分子表型、致瘤能力及其移植瘤的病理学特征.方法 应用神经干细胞培养基(NSCM)培养SHG-44胶质瘤细胞株,获取其胶质瘤干细胞球,纯化培养后行细胞免疫(ICC)荧光染色检测CD133、兔抗人巢蛋白(nestin)、A2B5、小鼠抗人波形蛋白(vimentin)、血管内皮细胞生长因子受体2(VEGFR-2)和IDH R132H的表达;含血清培养基诱导其分化,ICC检测CD133、nestin、vimentin、胶质纤维酸性蛋白(GFAP)、β-Ⅲ tubulin和半乳糖神经鞘氨醇酶(GalC)的表达情况;建立SHG-44胶质瘤干细胞球原位移植瘤模型,免疫组织化学检测CD133、nestin、VEGFR-2、GFAP、S-100和CD34的表达;比较SHG-44细胞原位模型和SHG-44干细胞球移植瘤的病理学特征.结果 应用神经干细胞培养法能成功获取SHG-44胶质瘤干细胞球.第10代SHG-44胶质瘤干细胞球和SHG-44胶质瘤细胞的CD133阳性细胞比例分别为(71.63±5.92)％和(1.95±1.45)％.SHG-44胶质瘤干细胞球的nestin、vimentin、VEGFR-2和A2B5阳性细胞比例分别为(84.06±7.58)％、(29.11 ±3.44)％、(64.44±3.69)％和(14.08 ±2.19)％.SHG-44胶质瘤干细胞球中可见IDH R132H突变的细胞群.含血清培养基诱导分化后,CD133、nestin、vimentin、GFAP、β-Ⅲ tubulin和GalC阳性细胞比例分别为(1.89±1.27)％、(6.67±2.75)％、(93.75±2.95)％、(91.33±4.75)％、(82.36±4.02)％和(8.92±3.19)％.原位移植瘤组织中GFAP、S-100和VEGFR-2蛋白表达呈阳性,CD133和nestin蛋白表达呈阴性.极少量特异抗人CD34阳性细胞围绕成管状.SHG-44胶质瘤干细胞球颅内原位移植瘤局部浸润能力高于SHG-44胶质瘤细胞颅内原位移植瘤.结论 神经干细胞培养法可成功从SHG-44胶质瘤细胞株中获取胶质瘤干细胞,属于CD133+ A2B5-亚群,高表达VEGFR-2,具备自我更新及多向分化能力,可参与血管拟态的形成.     

MGMT基因启动子甲基化检测在脑胶质瘤化疗中的意义

背景与目的：如何预测和克服肿瘤细胞对化疗药物的耐药性,实施个体化治疗是肿瘤化疗急需解决的问题。与基因启动子甲基化密切相关的DNA损伤修复基因O^6-甲基鸟嘌呤-DNA甲基转移酶（O^6-methylguanine-DNA methyhransferase,MGMT）表观沉默与肿瘤对烷化剂药物化疗敏感性密切相关。本研究探讨检测MGMT基因启动子CpG岛甲基化在判断脑胶质瘤患者预后及预测肿瘤对烷化剂药物耐药性中的意义。方法：甲基化特异性PCR（MSP）法检测脑胶质瘤组织及肿瘤细胞株MGMT基因启动子甲基化状态,蛋白印迹和免疫组化法测定蛋白表达。MTF法检测肿瘤细胞株对烷化剂药物敏感性,将患者随访资料针对MGMT甲基化状态绘制Kaplan-Meier生存曲线,并进行log—rank检验分析。结果：39例脑胶质瘤患者组织MGMT基因启动子甲基化发生率为46．2％,蛋白表达阳性率为61．5％,且肿瘤组织中MGMT基因甲基化状态与蛋白表达显著相关（P〈0．05）：6例正常组织均未检测出基因甲基化。MGMT基因过甲基化的脑胶质瘤SHG44细胞株用5-Aza-CdR处理后完全脱甲基化．MGMT蛋白恢复了表达,同时细胞株对烷化剂药物敏感性也发生逆转．由敏感转变为耐受。在采用手术、放疗和烷化剂尼莫司汀化疗等综合治疗的39例脑胶质瘤患者中,MGMT基因甲基化的患者生存率显著高于MGMT基因未甲基化患者（P〈0．05）。结论：MGMT基因甲基化状态与蛋白表达及肿瘤细胞对烷化剂药物敏感性密切相关,有可能替代MGMT蛋白检测成为判断脑胶质瘤患者预后和预测肿瘤对烷化剂化疗耐药性的标志分子。     

COX-2表达对脑胶质瘤的放射敏感性和细胞周期的影响

背景与目的COX-2在胶质瘤的发生发展过程中发挥重要作用,近年来发现COX-2抑制剂对一些胶质瘤细胞有增强放射敏感性的作用.本研究的目的在于观察人恶性脑胶质瘤细胞的COX-2蛋白表达和COX-1/COX-2双重抑制剂对乙酰氨基酚(acetaminophen,ACE)对细胞COX-2 mRNA表达、克隆形成率和细胞周期的影响,并探讨ACE提高胶质瘤细胞放射敏感性的机制.方法选用人恶性脑胶质瘤细胞株SHG-44作为研究对象.免疫细胞化学和RT-PCR检测细胞COX-2表达,成克隆分析法测定对乙酰氨基酚对细胞的放射增敏作用,流式细胞仪检测细胞周期分布.结果免疫细胞化学染色SHG-44细胞的胞膜和胞质均有COX-2蛋白表达.RT-PCR检测对乙酰氨基酚作用后细胞中COX-2mRNA表达降低.对乙酰氨基酚联合放疗作用于SHG-44细胞与单纯照射组相比,显示了放射增敏作用,增敏比为1.23(D0值水平)或1.43(Dq值水平).细胞周期检测发现,不同时间各组细胞都出现了不同的周期分布,照射后12 h单纯照射组和放射加药组G2/M期细胞明显多于对照组,24 h后单纯照射组迅速下降到与对照组相等的水平,而放射加药组仍维持较高比例(P＜0.01),同时对放射抗拒的S期细胞比例最低.结论人恶性脑胶质瘤细胞株SHG-44的胞膜和胞质均有COX-2蛋白表达,对乙酰氨基酚能增加该细胞株的放射敏感性,其机制可能与抑制COX-2表达、改变细胞周期分布有关.     

胶质瘤细胞株中ERCC1、ERCC2基因启动子区CpG岛的甲基化分析

背景与目的：NER是DNA修复系统中一个由多种蛋白组成的复杂网状系统，其中作为主要组成成分的ERCC1的表达同DDP化疗耐受相关，ERCC2的高表达同烷基药物化疗耐受相关。研究已经发现某些基因启动子区CpG岛的甲基化会导致基因的表达沉默，对化疗反应有指示作用，本文探讨ERCCI和ERCC2启动子区的甲基化状态和耐药的关系。方法：应用亚硫酸氢钠处理基因组DNA后PCR和不测序，我们分析了5个具有不同药敏特征的胶质瘤细胞株ERCC1和ERCC2的甲基化状态，人脑胶质瘤细胞株UW28，MGR1、MGR2、SF767和T98G和DDP和MeCCNU的敏感性采用MTT法检测。结果：在DDP敏感的细胞株中发现ERCC1基因启动子区上游4.9kb处存在甲基化的CpG岛，而在5个对BCNU耐药的细胞株中ERCC2的启动子区的CpG岛均呈去甲基化状态。结论：ERCC1和ERCC2畸变的甲基化状态与胶质瘤细胞株对化疗药的敏感性有关。     

洛铂联合多西他赛行肿瘤细胞减灭术加腹腔热灌注化疗治疗腹膜癌的临床观察

目的 分析洛铂联合多西他赛行肿瘤细胞减灭术（cytoreductive surgery, CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）治疗腹膜癌（peritoneal carcinoma, PC）的围手术期安全性及疗效。 方法 PC患者行CRS+HIPEC治疗,药物为洛铂50 mg/m2、多西他赛60 mg/m²,加入12 000 ml 0.9%氯化钠溶液加热至（43±0.5）℃持续灌注60 min。记录术后6天体温和心率变化、围手术期不良事件、血常规及血生化指标、术后患者恢复情况及生存结果。结果 90例PC患者行95次CRS+HIPEC,手术时间180~450 min (中位数485 min）;术后6天最高体温、心率分别为36.4℃~38.6℃（中位数37.5℃）、76~124 bpm（中位数100 bpm）,严重不良事件16例,包括围手术期死亡2例。中位生存期20.8月（95%CI: 13.1~25.8月）,1、3、5年生存率分别为75.6%、45.6%、43.3%。 结论 洛铂联合多西他赛进行CRS+HIPEC治疗PC安全性可接受,有助于延长患者生存期。     

Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR

EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient.     

参麦注射液对阿霉素所致大鼠心肌损伤保护作用的实验研究

目的　观察参麦注射液 (SMI)对阿霉素 (ADM )诱导大鼠心肌损伤的保护作用和抗氧化作用。方法　选用ADM诱导大鼠心肌损伤模型。SD大鼠 60只 ,随机分为 3个组 ,每组 2 0只 ,分别为正常组、治疗组、对照组。正常组 :实验第 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。治疗组 :实验第 1～ 9天注射参麦注射液 ,每天 3ml/kg ,1次 /天 ,第 4天注射阿霉素 ,隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。对照组实验 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。第 4天注射阿霉素 ,以后隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。到期测定血丙二醛 (MDA )含量和超氧化物歧化酶(SOD )活性 ,并进行心肌病理检查。结果　对照组MDA水平明显高于治疗组 ,对照组SOD水平则显著低于治疗组 ,即加用SMI可提高SOD活性 ,降低MDA含量。SMI能明显减轻大鼠心肌损伤 ,对照组与治疗组比较 ,治疗组心肌损伤明显减轻 ,治疗组与正常组比较无显著性差异。参麦注射液有抗氧化作用 ,与对照组比较 ,血SOD水平升高 ,MDA水平降低 ,心肌病理计分下降。结论参麦注射液有抗氧化作用和对阿霉素所引起的心脏毒性具有保护作用 ,为临床寻找有效的阿霉素所致心肌损伤保护药物提供良好的客观依据 ,值得临床推广应用     

Denosumab in patients with cancer and skeletal metastases: A systematic review and meta-analysis

Background

We conducted a systematic review of the literature to determine the efficacy and safety of denosumab in reducing skeletal-related events (SRE) in patients with bone metastases.

Methods

A literature search using MEDLINE, EMBASE, Web of Science and The Cochrane Collaboration Library identified relevant controlled clinical trials up-to-March 14, 2012. Two independent reviewers assessed studies for inclusion, according to predetermined criteria, and extracted relevant data. The primary outcomes of interest were SRE, time to first on-study SRE, and overall survival. Secondary outcomes included pain, quality of life, bone turnover markers (BTM), and adverse events.

Results

Six controlled trials including 6142 patients were analyzed. Compared to zoledronic acid, denosumab had lower incidence of SRE with a risk ratio (RR) of 0.84 (95% confidence intervals (CI) 0.80–0.88), delayed the onset of first on-study SRE (RR 0.83; 95% CI 0.75–0.90) and time to worsening of pain (RR 0.84; 95% CI 0.77–0.91). No difference was observed in overall survival with pooled hazard ratio of 0.98 (95% CI 0.90–1.0). For total adverse events, denosumab was similar to zoledronic acid (RR 0.97; 95% CI 0.89–1.0). No significant differences were observed in the frequency of osteonecrosis of the jaw (RR 1.4; 95% CI 0.92–2.1). Patients on denosumab had a greater risk of developing hypocalcemia (RR 1.9; 95% CI 1.6–2.3).

Conclusions

Denosumab was more effective than zoledronic acid in reducing the incidence of SRE, and delayed the time to SRE. No differences were found between denosumab and zoledronic acid in reducing overall mortality, or in the frequency of overall adverse events.     

体内诱导艾氏腹水瘤细胞的耐药性研究

肿瘤细胞耐药性的存在是临床化疗失败的主要原因之一。本实验在小鼠体内用阿霉素（ADR）诱导艾氏腹水瘤细胞（EHR）的耐药性，探讨细胞产生耐药性的机理。HPLC法测定细胞内药物浓度．结果表明耐药细胞─—EHR/ADR细胞内ADR积聚低于EHR细胞，而对ADR外排快于EHR细胞；异博定（VER）增加EHR／ADR细胞对ADR的摄取并阻滞其外排．而对EHR影响不大，揭示EHR／ADR细胞具有MDR特性。     

Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis

The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.     

邻近腋窝的上皮样血管内皮瘤1例报道

We described a case of a 71-year-old woman with an epithelioid hemangioendothelioma (EHE) in her left axilla,a rare location which hasn't been reported yet. The patient suffered from numbness, pain and decreased muscle strength of her left upper extremity. Sonography revealed a hypoechoic mass surrounded the axillary artery and brachial artery. No obvious capsule was demonstrated. CT showed a soft-tissue mass with some calcifications and peripheral ring-like en-hancement. The MRI indicated a mass with mainly intermediate signal intensity on Tl-weighted imagine and intermediate signal intensity on T2-weighted imagine. The diagnosis was confirmed by histopathologic examination after surgery. There are some correlations of these imaging features with its histopathologic characters.     

GF方案与TP方案一线治疗晚期非小细胞肺癌的临床对照研究

Objective  

The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin (GP) and paclitaxel plus cisplatin (TP) 1st-line chemotherapies for advanced non-small cell lung cancer (NSCLC) and observe their side effects.     

鼻咽癌患者放射性骨坏死引起的正电子显像假阳性结果1例及文献复习

目的:探讨鼻咽癌(NPC)患者放射性骨坏死(osteoradionecrosis,ORN)引起正电子假阳性结果的原因及避免因此引发诊断错误的方法。方法:回顾性分析1例放疗后的鼻咽癌患者,行鼻咽部MRI及正电子显像后,再行组织病理学检查,对三种结果进行分析、比较。结果:MRI及正电子显像均诊断患者颅底区域肿瘤复发,组织病理学结果则显示鼻咽部病灶为放射性骨坏死。因此正电子扫描结果为假阳性结果。结论:鼻咽癌患者放疗后所致的放射性骨坏死容易引起正电子显像假阳性结果并可能引发不必要的治疗,因此NPC患者的正电子图像,对于可能的局限性肿瘤复发诊断,应该非常慎重。     

Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration.