Coexistence of CML and Multiple Myeloma: A Case Study
Posted: Wednesday, December 12, 2018
A report, published in Case Reports in Hematology, described a rare case of the co-occurrence of p190 BCR-ABL–type chronic myeloid leukemia (CML) and multiple myeloma in a 76-year-old man. Following a literature review, Shigeru Chiba, MD, PhD, of the University of Tsukuba, Japan, and colleagues identified several possibilities for the coexistence of the two diseases, including coincidence, common precursors, or a therapy-related malignancy.
The authors claim that the case is the first reported coexistence of multiple myeloma and p190 BCR-ABL CML. Just 24 other cases of multiple myeloma and CML have been reported in the same patient, all of which involved individuals with p210-type BCR-ABL leukemia.
The man was first diagnosed with multiple myeloma after authors observed the presence of serum M-protein, lytic bone lesions, and abnormal plasma cells in the bone marrow. After not responding to bortezomib plus dexamethasone or cyclophosphamide, bortezomib, and dexamethasone, he achieved a partial response to lenalidomide and dexamethasone treatment. After 2 years, he was diagnosed with p190 BCR-ABL CML. At that time, he received initial treatment of dasatinib for CML in accelerated phase and achieved a partial cytogenetic response 4 months after the diagnosis.
The study authors highlighted a handful of reasons that may explain how the two diseases coexist. First, although rare, it may be purely coincidental. Second, “clonal hematopoiesis of indeterminate potential,” or common precursors, may progress cells of both diseases in a single patient. Third, the second disease to develop may be related to a treatment received for the first disease—in this case, it is possible that cyclophosphamide, an alkylating agent, may have caused the development of leukemia; however further research is necessary to draw definitive conclusions.