Lenalidomide and secondary acute lymphoblastic leukemia: a case series

Tan, Marisela; Fong, R.; Lo, Mimi; Young, Rebecca

doi:10.1002/hon.2248

Cited by 28 publications

(19 citation statements)

References 15 publications

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“…[7] Recently, Tan et al reviewed a case series in which patients receiving lenalidomide maintenance therapy developed secondary ALL. [4] Consistent with their report, the patient in the present study continued to take thalidomide as a maintenance treatment for many years, which may have caused the development of secondary ALL.…”

Section: Discussionsupporting

confidence: 90%

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Multiple myeloma secondary to acute lymphoblastic leukemia

Shen²,

Liu³

et al. 2019

Medicine

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Rationale:Acute lymphoblastic leukemia (ALL) secondary to multiple myeloma (MM) is rare. Here we report a rare case of secondary ALL transformed from MM.Patient concerns:A 64-year-old woman was diagnosed as MM IgG light chain type in 2001. She achieved complete remission after 2 cycles of therapy, and received maintenance therapy with thalidomide. The patient suffered from MM relapse in September 2011. Bone marrow examination showed that the percentage of primary lymphocytes was 59%, indicating ALL-L2 (Pre-B-ALL). The patient reached complete remission after 1 cycle of chemotherapy, and has been maintained for more than 6 years.Diagnoses:Immunophenotyping analysis revealed that the abnormal cell population accounted for approximately 66% which expressed HLA-DR, CD4, CD22, CD33, CD34, and cCD79a. These results indicated acute B lymphoblastic leukemia. Chromosome presented 47, XX, +5, −7, +19. Leukemia fusion gene analysis demonstrated positive EVI1 and negative IgH and TCR gene rearrangement.Interventions:The patient accepted 1 cycle of VDCLP chemotherapy and reached complete remission, followed with consolidation therapies with VDCLP, MA, CAG and other chemotherapy regimens.Outcomes:This patient has maintained CR1 of ALL for more than 6 years.Lessons:Even secondary lymphoblastic leukemia has been rarely reported in patients with MM, we still need perform bone marrow examination, flow cytology, and gene tests, especially during maintenance therapy.

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Section: Discussionsupporting

confidence: 90%

“…However, a case of MM secondary to acute lymphoblastic leukemia (ALL) is rarely reported. [1–4] In the present study, we report a patient with MM secondary to ALL and reviewed the related literature.…”

Section: Introductionmentioning

confidence: 99%

Multiple myeloma secondary to acute lymphoblastic leukemia

Shen²,

Liu³

et al. 2019

Medicine

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“…A total of 928 patients treated in the REMoDL-B trial 15 (Data Supplement) were included in this retrospective study. Genome-wide gene expression data were available for all patients from formalin-fixed paraffin-embedded tissue samples.…”

Section: Methodsmentioning

confidence: 99%

“…The Randomized Evaluation of Molecular-Guided Therapy for DLBCL With Bortezomib (REMoDL-B) clinical trial 15 tested standard therapy for DLBCL (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone [R-CHOP]) against its combination with the proteasome inhibitor bortezomib (RB-CHOP). The hypothesis was that bortezomib indirectly inhibits the nuclear factor kappa-light-chain-enhancer of activated B cells pathway believed to be specifically active in the ABC variant.…”

Section: Introductionmentioning

confidence: 99%

Molecular High-Grade B-Cell Lymphoma: Defining a Poor-Risk Group That Requires Different Approaches to Therapy

Sha

Barrans

Cucco

et al. 2019

JCO

234

275

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Purpose Biologic heterogeneity is a feature of diffuse large B-cell lymphoma (DLBCL), and the existence of a subgroup with poor prognosis and phenotypic proximity to Burkitt lymphoma is well known. Conventional cytogenetics identifies some patients with rearrangements of MYC and BCL2 and/or BCL6 (double-hit lymphomas) who are increasingly treated with more intensive chemotherapy, but a more biologically coherent and clinically useful definition of this group is required. Patients and Methods We defined a molecular high-grade (MHG) group by applying a gene expression–based classifier to 928 patients with DLBCL from a clinical trial that investigated the addition of bortezomib to standard rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The prognostic significance of MHG was compared with existing biomarkers. We performed targeted sequencing of 70 genes in 400 patients and explored molecular pathology using gene expression signature databases. Findings were validated in an independent data set. Results The MHG group comprised 83 patients (9%), with 75 in the cell-of-origin germinal center B-cell-like group. MYC rearranged and double-hit groups were strongly over-represented in MHG but comprised only one half of the total. Gene expression analysis revealed a proliferative phenotype with a relationship to centroblasts. Progression-free survival rate at 36 months after R-CHOP in the MHG group was 37% (95% CI, 24% to 55%) compared with 72% (95% CI, 68% to 77%) for others, and an analysis of treatment effects suggested a possible positive effect of bortezomib. Double-hit lymphomas lacking the MHG signature showed no evidence of worse outcome than other germinal center B-cell-like cases. Conclusion MHG defines a biologically coherent high-grade B-cell lymphoma group with distinct molecular features and clinical outcomes that effectively doubles the size of the poor-prognosis, double-hit group. Patients with MHG may benefit from intensified chemotherapy or novel targeted therapies.

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“…We report here the case of a 70-year-old who has been under therapy for Multiple Myeloma for 8 years with various multi-agent regimens and was in a partial remission on single agent lenalidomide, when she developed pre-B ALL. Lenalidomide has been suggested to play a role in the development of secondary ALL in the context of myeloma therapy [4]. We elected to treat her with blinatumomab after deeming her unfit for conventional ALL induction therapy and definitive management with allogeneic transplant due to age and comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Blinatumomab Induced Response of Multiply Refractory Multiple Myeloma in the Context of Secondary Pre-B Cell Acute Lymphoblastic Leukemia

Pratz¹

2017

Ann Hematol Oncol

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We report the case of a 70 year old female who developed Pre-B Acute Lymphoblastic Leukemia (ALL) while undergoing lenalidomide therapy for multiple myeloma (MM). Molecular studies of the ALL revealed hypodiploid karyotype with distinct genetic changes other than those seen in prior myeloma samples. She underwent cytoreductive therapy with prednisone and cyclophosphamide and then received induction with blinatumomab. After her first cycle, she achieved a MRD negative complete remission of her ALL and a deepening of her MM remission to a VGPR by IMWG criteria. She went on to get a second cycle of blinatumomab with continued complete remission of her ALL, normalization of complete blood count and an ongoing VGPR of her MM. Laboratory studies have established the myeloma stem cell is CD19 positive suggesting a potential mechanism of action of improvement of her myeloma in this case.

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Lenalidomide and secondary acute lymphoblastic leukemia: a case series

Cited by 28 publications

References 15 publications

Multiple myeloma secondary to acute lymphoblastic leukemia

Multiple myeloma secondary to acute lymphoblastic leukemia

Molecular High-Grade B-Cell Lymphoma: Defining a Poor-Risk Group That Requires Different Approaches to Therapy

Blinatumomab Induced Response of Multiply Refractory Multiple Myeloma in the Context of Secondary Pre-B Cell Acute Lymphoblastic Leukemia

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