Immunoglobulin D Multiple Myeloma, Plasma Cell Leukemia and Chronic Myelogenous Leukemia in a Single Patient Treated Simultaneously with Lenalidomide, Bortezomib, Dexamethasone and Imatinib

Abstract

Multiple myeloma (MM) is a neoplastic lymphoproliferative disorder characterized by uncontrolled monoclonal plasma cell proliferation. Among different isotypes of MM, immunoglobulin D (IgD) MM is very rare, representing only 1 to 2% of all isotypes. Chronic myelogenous leukemia (CML) is a neoplastic myeloproliferative disorder of pluripotent hematopoietic stem cell, which is characterized by the uncontrolled proliferation of myeloid cells. An 88-year-old male was diagnosed simultaneously with IgD kappa MM and CML. A distinctive feature in this patient was the progression to plasma cell leukemia without any symptomatic myeloma stage. He was treated simultaneously with lenalidomide, bortezomib and imatinib. Synchronous occurrence of these rare hematological malignancies in a single patient is an exceedingly rare event. Multiple hypotheses to explain co-occurrence of CML and MM have been proposed; however, the exact etiological molecular pathophysiology remains elusive.

An Unprecedented Case of p190 BCR-ABL Chronic Myeloid Leukemia Diagnosed during Treatment for Multiple Myeloma: A Case Report and Review of the Literature

“…There have only been 24 cases of coexisting MM and CML reported ( Table 1 ) [ 3 – 25 ]. MM and CML were diagnosed simultaneously in 9 cases, and the diagnoses were sequential in the remaining cases, with MM being diagnosed first in 8 cases and CML being diagnosed first in 7 cases.…”

Multiple myeloma in a patient with chronic myeloid leukemia: A case report

“…Notably, given the large number of chromosomal abnormalities existing in the present patient, the genetic instability of the host may have produced an atypical progenitor cell, placing this patient in a more vulnerable position to acquire multiple disorders. Furthermore, during the treatment, the expression of NF-κB signaling pathway is downregulated, and these malignant cells gain anti-apoptotic abilities and mechanisms, and evade immune surveillance in the context of immune response loss or decline (5,6,23,24). The progression or treatment of malignant tumors enhances the development of malignant cells (gaining anti-apoptotic abilities) and the mechanisms of evading immune surveillance, chronic antigen stimulation and genetic polymorphism (23,25).…”

“…To the best of our knowledge, these 2 uncommon diseases in the same patient is extremely rare, and, since 1972, there have been 15 cases reported in the world literature. MM accompanied by CML is rare, and few related studies have been reported worldwide since 1972 (5)(6)(7)(8). A literature review shows that new hematopathological neoplasms occur following the initial treatment of a hematological malignancy (7,(9)(10)(11).…”

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

“…At present there are multiple theories but insufficient data to make any definite conclusions about the mechanism of co-existence of CML and MM. With the advent of novel therapies and improving survival in patients with CML and MM, there is value in further investigation regarding the pathophysiology and clinical characteristics of such cases 2,3 . Additionally, the occurrence of more than one hematological malignancy in the same patient presents treatment challenges because it can lead to the possibilities of drug-drug interactions and medication toxicities.…”