Multiple myeloma secondary to acute lymphoblastic leukemia

Abstract

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.

Transcription factor 12‐mediated self‐feedback regulatory mechanism is required in DUX4 fusion leukaemia

“…The VDCLP protocol (comprising vincristine, daunomycin, cyclophosphamide, asparaginase, and dexamethasone) are frequently used in the treatment of ALL 35 . Furthermore, an important contributing factor to relapse in patients with ALL is the development of drug resistance in tumour cells.…”

“…The VDCLP protocol (comprising vincristine, daunomycin, cyclophosphamide, asparaginase, and dexamethasone) are frequently used in the treatment of ALL. 35 Furthermore, an important contributing factor to relapse in patients with ALL is the development of drug resistance in tumour cells. Here, we selected vincristine, the most effective chemo agent in the clinical management of B‐ALL, to monitor the IGH4::IGH–TCF12 cooperation in drug resistance.…”