Abstract. Primary plasma cell leukemia (pPCL) is an uncommon form of plasma cell dyscrasia, and the most aggressive of the human monoclonal gammopathies. The t(11;14)(q13;q32) rearrangement is the most common alteration in pPCL, promoting cyclin D1 (CCND1) gene overexpression caused by its juxtaposition with the immunoglobulin heavy locus chromosome region. The myeloma overexpressed (MYEOV) gene maps very close to the CCND1 gene on chromosome 11, but its overexpression is rarely observed in multiple myeloma. The present study describes a case of pPCL with t(11;14) characterized by a breakpoint on der(11), unlike the one usually observed. Droplet digital polymerase chain reaction analysis revealed overexpression of CCND1 and MYEOV. To the best of our knowledge, MYEOV gene overexpression has never been previously described in pPCL.
IntroductionPrimary plasma cell leukemia (pPCL) is an uncommon form of plasma cell (PC) dyscrasia, and the most aggressive of the human monoclonal gammopathies (1,2). pPCL is characterized by the presence of >20% circulating PCs in peripheral blood and/or an absolute circulating PC count exceeding 2x10 9 cells/l (1). Peripheral blood flow cytometry is an important tool to demonstrate the presence of PCs and to confirm their clonality, as well as to exclude other lymphoproliferative disorders such as low-grade B-cell and lymphoplasmacytic lymphoma (2). In regard to cytogenetic findings, the t(11;14)(q13;q32) rearrangement is the most common alteration in pPCL (3), promoting cyclin D1 (CCND1) gene overexpression due to its juxtaposition with the immunoglobulin heavy locus (IGH) chromosome region. The subsequent deregulation of CCND1 is considered to perturb the G1-S phase transition of the cell cycle and, therefore, to contribute to tumor development (4). However, the IGH/CCND1 rearrangement alone may be insufficient to cause hematologic malignancies, and may require other additional genetic aberrations to boost its oncogenic activity (4). In the present study, a case of pPCL with t(11;14) characterized by the overexpression of CCND1 and the myeloma overexpressed (MYEOV) gene, which maps very close CCND1 on chromosome 11, is described.
Materials and methodsClinical history. In July 2014, a previously healthy 65-year-old male was admitted to the Department of Emergency and Organ Transplantation, Hematology Section, University of Bari (Bari, Italy) for anemia, thrombocytopenia and mild leukocytosis [hemoglobin levels, 11.0 g/dl (normal range, 13.0-16.0 g/dl); platelets, 49x10 9 cells/l (normal range, 150-450x10 9 cells/l); and leukocytes, 13x10 9 cells/l (normal range, 4-10x10 9 cells/l)]. Peripheral blood smear analysis demonstrated the presence of ~40% apparently undifferentiated cells, a number of which had a large eccentric nucleus and scattered chromatin, while others had a scanty and intensely basophilic cytoplasm with protrusions (Fig. 1A-C). Immunophenotypic analysis of bone marrow (BM) demonstrated the specimen to be cluster of differentiation (CD)38+, CD138+, CD20-, CD23-, CD56+, ...