Case Report: IgG multiple myeloma and chronic myeloid leukemia in a single patient

Neeraja Swaminathan,Claudia Dourado,Sorab Gupta

doi:10.12688/f1000research.24086.1

Abstract

A 58-year-old man presented with recurrence of chronic myeloid leukemia (CML) after complete molecular remission in the setting of non-compliance with imatinib. He was restarted on imatinib and was also noted to have IgG kappa monoclonal gammopathy of undetermined significance (MGUS). The patient re-achieved molecular remission after resumption of imatinib, but his MGUS progressed to smoldering myeloma and he was eventually diagnosed with multiple myeloma (MM) and initiated on treatment for MM with thalidomide, bortezomib and dexamethasone. He has responded well to treatment of the myeloma and continues concurrent maintenance imatinib treatment for CML and is being evaluated for bone marrow transplant. The association of two concurrent hematological malignancies, CML and MM, is very rare and has been infrequently reported in literature. The pathophysiology of this has not yet been fully understood. This case report reviews the various theories to explain this and discusses the potential challenges of simultaneous treatment of MM and CML.

Highlights

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of pluripotent hematopoietic stem cells
This case report presents an experience with a CML patient who over time progressed to develop the entire spectrum of myeloma, starting with monoclonal gammopathy of undetermined significance (MGUS) followed by smoldering myeloma and MM requiring treatment
Both MGUS and smoldering myeloma are characterized by an absence of myeloma defining events

Summary

Introduction

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of pluripotent hematopoietic stem cells. With regard to the patient’s CML, he achieved molecular remission in November 2016 with 3 log reduction in the 3 tested transcripts b2a2, b3a2, e1a2 and without detectable Philadelphia chromosome He had a steady increase in the paraprotein level from December 2015 to April 2019 without any symptoms. The patient was started on treatment for ISS stage II standard risk myeloma with thalidomide (50mg/day daily for 21 days followed by 7 days off), weekly bortezomib (1.3mg/m2) and dexamethasone (40mg/day once a week) in September 2019 This regimen was preferred over the VRd (lenalidomide, bortezomib and dexamethasone) due to the concern for increased risk of pancytopenia with concurrent use of imatinib and lenalidomide. He has received four cycles of treatment for myeloma along with the concurrent imatinib and has tolerated it well with no dose limiting toxicities

Discussion

Findings

Conclusion

Rajkumar SV: Multiple myeloma