Plasmacytosis in acute myeloid leukemia: two cases of plasmacytosis and increased IL-6 production in the AML blast cells

Abstract

An increased plasma cell count in the bone marrow occurs in a subgroup of patients with acute myeloid leukemia (AML). The pathogenic mechanism for this plasmacytosis is unclear. In this report we describe two patients with AML and plasmacytosis who shared some features of their diseases. The morphological subtypes were AML M4 and M4eo; the leukemias were secondary to cytotoxic pretreatment, and complex cytogenetic changes were found in the leukemic cells of both patients. There was a marked increase in the number of bone marrow plasma cells in both cases and no monoclonal immunoglobulin was detectable. The IgH-CDR3 gene scan depicted a monoclonal IgH rearrangement in the bone marrow cells of one patient. Analysis of the cytokine production of the leukemic cells showed a high production of IL-6 of the leukemic blast cells in the in vitro cell culture and a high cytoplasmic IL-6 in the leukemic cells as revealed by immunocytology. We describe the clinical picture of a type of secondary AML with FAB M4 morphology associated with bone marrow plasmacytosis. We suggest that paracrine growth stimulation of plasma cells by paraneoplastic IL-6 production of the leukemic blast cells contributes to the plasmacytosis observed in patients with AML.

Light chain Fanconi syndrome in a patient with acute myeloid leukemia and monoclonal gammopathy of undetermined significance

“…There have been case reports of LCFS in patients with chronic lymphocytic leukemia, Waldenstrom's macroglobulinemia, and diffuse large B-cell lymphoma, but never in a patient Note that urine glucose was checked on hospital day 16 which was 7 days after initiation of treatment with AML [5]. Plasmacytosis is an uncommon occurrence in AML and so it is more likely that this patient had both AML and, coincidentally, MGUS with LCFS [8,10,11]. The frequency of MGUS in patients over 50 is about 3 % and this increases with age [9].…”

Florid plasmacytosis in a case of acute myeloid leukemia: A diagnostic dilemma

“…Morphological features suggesting a reactive nature of plasma cells, although not specific, are mature forms of plasma cells, perivascular location of plasma cells and plasmacytic satellitosis (orientation of plasma cells around histiocytes). [5]…”

“…[5–7] In these cases, plasma cells usually do not exceed 10%. However, there are very few cases where the plasma cell count is found to be higher than 20% in newly diagnosed acute leukemias.…”

A Case of Acute Promyelocytic Leukemia Concomitant with Plasma Cell Myeloma

“…Before concluding that plasmacytosis is associated with clonal hematologic malignancy or PCM, reactive plasmacytosis should be ruled out because plasmacytosis can co-occur with AML [10], in which interleukin-6 production by leukemic blasts may stimulate plasma cell growth [11]. The patient's various chronic conditions confounded the assessment of CRAB (hypercalcemia, renal insufficiency, anemia, and bony lesion) to prove end-organ damage by PCM.…”

“…The proposed reasons for concurrent presentation of 2 different hematologic malignancies are abnormal multipotent stem cells, environmental risk factors, repeated infections that result in the development of a leukemic clone, and decreased immune surveillance, which may result in failure to eliminate leukemic clones [6, 11, 14]. …”