Case Report: IgG multiple myeloma and chronic myeloid leukemia in a single patient

Abstract

A 58-year-old man presented with recurrence of chronic myeloid leukemia (CML) after complete molecular remission in the setting of non-compliance with imatinib. He was restarted on imatinib and was also noted to have IgG kappa monoclonal gammopathy of undetermined significance (MGUS). The patient re-achieved molecular remission after resumption of imatinib, but his MGUS progressed to smoldering myeloma and he was eventually diagnosed with multiple myeloma (MM) and initiated on treatment for MM with thalidomide, bortezomib and dexamethasone. He has responded well to treatment of the myeloma and continues concurrent maintenance imatinib treatment for CML and is being evaluated for bone marrow transplant. The association of two concurrent hematological malignancies, CML and MM, is very rare and has been infrequently reported in literature. The pathophysiology of this has not yet been fully understood. This case report reviews the various theories to explain this and discusses the potential challenges of simultaneous treatment of MM and CML.

Prevalence and Clinical Characteristics of Paraproteinemia Associated with Chronic Myeloid Leukemia

“…None of our patients was diagnosed with active MM. In the literature, the coexistence of MM and CML in a single patient has rarely been reported, with only several dozens reported so far [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Most reported cases included patients in whom the diagnosis of MM followed a prolonged treatment period with imatinib for CML, leading to the hypothesis of a possible link between this treatment and the development of MM [5][6][7][8][9][10][11][12].…”

“…In the literature, the coexistence of MM and CML in a single patient has rarely been reported, with only several dozens reported so far [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Most reported cases included patients in whom the diagnosis of MM followed a prolonged treatment period with imatinib for CML, leading to the hypothesis of a possible link between this treatment and the development of MM [5][6][7][8][9][10][11][12]. Carulli et al [38] found imatinib treatment for CML to induce a plasma cell phenotype with the same characteristics as that in monoclonal gammopathies according to multiparametric flow cytometry from bone marrow aspirates of 30 CML patients treated with imatinib.…”

“…Though originating from different cell origins, case reports published over the years have described patients with the coexistence of CML and MM or other paraproteinemias. In some cases, the CML diagnosis and tyrosine kinase inhibitor (TKI) treatment preceded the diagnosis of MM [5][6][7][8][9][10][11][12], raising concern that TKI treatment may have contributed toward MM development. In other cases, the MM preceded the diagnosis of CML [13][14][15][16][17][18], while a few had both diseases simultaneously diagnosed [19][20][21][22][23].…”