Unusual Case of Simultaneous Presentation of Plasma Cell Myeloma, Chronic Myelogenous Leukemia, and a Jak2 Positive Myeloproliferative Disorder

Abstract

Background. Multiple articles discuss the rare incidence and potential causes of second hematologic disorders arising after treatment of Chronic Myelogenous Leukemia (CML), leading to the theory of imatinib, the current treatment regimen for CML, as a possible trigger for the development of secondary neoplasms. Our case eliminates the possibility of imatinib as the sole cause since our patient received a diagnosis of simultaneous plasma cell myeloma, CML, and a Jak2 mutation positive myeloproliferative disorder (MPD) arising de novo, prior to any treatment. We will further investigate into alternative theories as potential causes for multiple hematopathologic disorders. Case Report. There are currently no reported cases with the diagnosis of simultaneous plasma cell myeloma, chronic myelogenous leukemia, and Jak2 positive myeloproliferative disorder. We present a case of a 77-year-old male who was discovered to have these three concurring hematopathologic diagnoses. Our review of the literature includes a look at potential associations linking the three coexisting hematologic entities. Conclusion. The mechanism resulting in simultaneous malignancies is most likely multifactorial and potentially includes factors specific to the host, continuous stimulation of the immune system, previous chemotherapy or radiation, a potential common pluripotent stem cell, or, lastly, preexisting myeloma which may increase the susceptibility of additional malignancies.

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

“…Based on National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) data, there is an increased risk of secondary hematological malignancies after MM and CML. 4 , 5 , 16 , 17 However, co-occurrence of these two disorders in one patient is exceedingly rare, described very infrequently in the literature ( Table 2 ). 4-14 Most of these cases were diagnosed sequentially with one disease preceding the other with varying time intervals between the two diagnoses.…”

“… 2-4 Co-occurrence of these two disorders in one patient is an extremely rare event, described in a handful of cases in the literature. 4-14 We describe an exceedingly rare case of simultaneous immunoglobulin D kappa MM with plasma cell leukemia (PCL) and CML which, to our knowledge, has not been reported in the literature.…”

Hodgkin lymphoma in a case of chronic myeloid leukemia treated with tyrosine kinase inhibitors

“…After completion of 3 cycles of chemotherapy, PET-CT was performed and revealed complete metabolic and significant morphological regression of all the previous nodal and extra-nodal disease, with no new metabolically active lesion. Factors that are thought to contribute to the coexistence of hematological malignancies include host-specific characteristics, environment, history of previous chemotherapy and radiation or a possible common hematologic stem cell (4). Host-specific factors may include age, gender, race, genetic make-up, and life style choices.…”

Case Report: Concomitant Diagnosis of Plasma Cell Leukemia in Patient With JAK2 Positive Myeloproliferative Neoplasm

“…There are several published reports of patients with concomitant myeloproliferative neoplasms (MPN) and plasma cell dyscrasias (PCD), the peculiarity of which being that these two malignancies arise from separate lineages in the hematopoietic ancestral tree ( 1 , 2 ). Apart from case reports of patients with MPNs and PCDs, one prospective study found the coexistence of monoclonal gammopathy of undetermined significance (MGUS) in patients with a MPN to be 8.2%, which is higher than the average prevalence of MGUS in the general population (3%) ( 3 , 4 ).…”