Secondary plasma cell leukemia: Case report

Abstract

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by monoclonal proliferation of plasma cells in marrow and peripheral blood. It is defined by a blood plasma count greater than 2 G/l or a plasma cell count greater than 20% of white blood cells. There are two forms of PCL: primary PCL (primary plasma cell leukemia or PCL-P), which occurs de novo and is diagnosed by blood dissemination, and secondary PCL (secondary plasma cell leukemia or SPL), which is the result of the evolution of multiple myeloma (MM). We report an observation of secondary plasma cell leukemia in a 42-year-old female patient diagnosed at the hematology laboratory of the Mohamed VI University Hospital in Marrakech. The patient was being followed up for chronic end-stage renal failure in whom the etiological assessment of a hypercalcemia of fortuitous discovery revealed MM for which she was put on chemotherapy according to the Velcade-Thalidomide-Dexamethasone protocol with a good evolution after 6 courses. Two and a half years later, the patient presented with anemia and spinal pain. The biological work-up showed a normocytic normochromic anemia at 5.4 g/dl and hypercalcemia at 150 mg/l. The blood smear showed the presence of 22% of circulating plasma cells, the majority of which were dystrophic, in favor of secondary plasma cell leukemia. Patients diagnosed with multiple myeloma who have undergone treatment and have a stable disease should have regular surveillance, hence the interest of the blood smear examination in all multiple myeloma.