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How we manage Bing–Neel syndrome
Author(s) -
Castillo Jorge J.,
Treon Steven P.
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16167
Subject(s) - ibrutinib , medicine , fludarabine , magnetic resonance imaging , cerebrospinal fluid , bruton's tyrosine kinase , lymphoplasmacytic lymphoma , methotrexate , pathology , waldenstrom macroglobulinemia , tyrosine kinase , immunology , chemotherapy , lymphoma , radiology , leukemia , cyclophosphamide , chronic lymphocytic leukemia , receptor
Summary Bing–Neel syndrome (BNS) is an uncommon presentation of Waldenström macroglobulinaemia (WM), seen during the course of the disease in about 1% of patients. BNS occurs when WM cells gain access to the central nervous system (CNS) causing neurological deficits. The diagnosis of BNS is suggested by the presence of radiological abnormalities, such as leptomeningeal enhancement on magnetic resonance imaging and confirmed by the presence of clonal lymphoplasmacytic cells and MYD88 L265P in the cerebrospinal fluid. The treatment of BNS requires agents with good penetration into the CNS, such as fludarabine, methotrexate and cytarabine. The novel Bruton Tyrosine Kinase inhibitor ibrutinib has shown CNS‐penetrating properties, and recent data suggest a therapeutic role in BNS. In this review, we will discuss the clinical and pathological features, diagnostic criteria, treatment options and outcomes of patients with BNS.