Acute Promyelocytic Leukaemia Complicating Multiple Myeloma: Evidence of Different Cell Lineages

Abstract

The association of leukemia and multiple myeloma is well described usually as a complication of chemotherapy but also in the absence of chemotherapy or at diagnosis. Such leukemias are typically acute myeloid leukemia (AML), particularly myelomonocytic subtype, and cases of acute promyelocytic leuke (APL) are rarely reported. Controversy exists as to whether myeloma and AML originate from a single haematopoietic progenitor or arise from different cell lineages. We report a case of a 58 year old female who developed APL 10 months following diagnosis of nonsecretory light chain (kappa) myeloma which had been treated with local spinal irradiation and low dose oral melphalan and prednisone. Clonality had originally been demonstrated by light chain restriction (kappa) of her bone marrow plasma cells whilst immunoglobulin heavy chain and T cell receptor genes were germ line. At development of APL cytogenetics revealed t(15;17) and PML-RAR fusion gene was detected by RT-PCR. The patient was treated with all-trans retinoic acid (ATRA) and received 2 cycles of consolidation chemotherapy with Idarubicin. Following this therapy the t(15;17) and PML-RAR were both undetectable whilst the clonal population of kappa staining plasma cells persisted. This particular patient represents a rare case of APL complicating multiple myeloma with persistence of the myeloma clone but disappearance of PML-RAR alpha RNA following therapy. This case study appears to support the argument that the APL and myeloma originated from distinct cell lineages.

Partial remission of acute myeloid leukemia complicating multiple myeloma following COAP chemotherapy: A case report

“…With such improvements, a relatively new clinical challenge that has emerged is the risk of second malignancies. The association of acute leukemia [most frequently acute myeloid leukemia (AML)] and MM has often been reported, not only as a complication of chemotherapy, but also occurring in the absence of chemotherapy or simultaneously at the time of diagnosis ( 4 ). Prior studies have found that various therapies have made a contribution to secondary malignancies following multiple myeloma ( 5 ).…”

Coexistence of Acute Promyelocytic Leukemia and Primary Plasma Cell Leukemia: Careful Consideration in Diagnosis

“…Molecular confirmation for identifying a PML-RARA rearrangement has to be performed when APL is suspected. In rare cases, APL coexists with other hematologic malignancies, and in such cases, the concomitant malignant cells could be underestimated [ 2 - 4 ]. We report a case of APL coexisting with primary plasma cell leukemia (PCL) without any history of chemotherapy.…”

Therapy-related acute promyelocytic leukemia in plasma cell myeloma treated with melphalan: a case report and literature review

“…Cases of t-APL arising from plasma cell myeloma (PCM) are known to be rare, although they have been reported in a few instances associated with melphalan treatment. However, the effect of melphalan treatment alone on t-APL is obscure owing to the frequent use of combination therapy including topoisomerase II agents, other types of anti-cancer drugs, and/or RT [2345]. Herein, we report a very rare case of t-APL arising from PCM treated with melphalan only as a cytotoxic agent with a review of the literature.…”

“…Cases of t-AML following treatment of PCM with alkylating agents including melphalan and/or RT were reported from time to time [11121314]. These cases usually corresponded to M1, M4 (myelomonocytic), or M6 under the past French-American-British (FAB) classification system; however, cases of M3 (Table 1), i.e., APL, were very rare [2345]. Two of 4 cases were treated with MP plus RT [35].…”

“…These cases usually corresponded to M1, M4 (myelomonocytic), or M6 under the past French-American-British (FAB) classification system; however, cases of M3 (Table 1), i.e., APL, were very rare [2345]. Two of 4 cases were treated with MP plus RT [35]. In the remaining 2 cases, melphalan and other cytotoxic agents without RT had been utilized in 1 case [2], and the name of the chemotoxic agent was not mentioned in the article for the other case, but RT was used [4].…”