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Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Shaji K. Kumar, MD
Prashant Kapoor, MD, FACP
Posted: Monday, March 27, 2023
Reportedly the first documented case of a triple combination of primary cancers in a single patient, including the rare coexistence of chronic myeloid leukemia (CML) and multiple myeloma, was recently published in the Journal of Medical Case Reports. The cause of these coexisting cancers remains unknown but may be multifactorial in nature, suggested Amirhosein Maharati, MD, of Mashhad University of Medical Sciences, Iran, and colleagues.
“The occurrence of chronic myelogenous leukemia and multiple myeloma in the same patient is unusual; it may suggest a correlation between the two separate hematological malignancies rather than an incidental occurrence,” explained the study authors.
The patient was an 85-year-old man who presented with new-onset left-upper quadrant pain, fatigue, and weight loss after a diagnosis of prostate cancer up to 1 year ago. He was found to have reduced levels of hemoglobin, mean corpuscular hemoglobin concentration, and mean corpuscular hemoglobin. Furthermore, he had leukocytosis and thrombocytosis.
A real-time polymerase chain reaction was performed and was positive for BCR/ABL P210 fusion gene t9;22, which was indicative of CML. The patient was immediately started on imatinib therapy, which was ineffective after 2 years. He was subsequently given a second-generation tyrosine kinase inhibitor, nilotinib, and was found to be responsive to treatment.
After 5 years of follow-up, the patient returned with complaints of lethargy, weight loss, nausea, and bone pain. He had an elevated creatinine level with associated anemia and thrombocytopenia. His BCR-ABL1 levels were measured and remained negative. Electrophoresis revealed a monoclonal immunoglobulin G level, which suggested multiple myeloma. However, there was no evidence of Bence-Jones proteins in his urine protein electrophoresis. A whole-body scan was performed to assess the presence of metastasis, which was negative. The patient subsequently received a bone marrow biopsy that showed 60% immature plasma cells, which further suggested a diagnosis of multiple myeloma. The patient died despite treatment.
Disclosure: The study authors reported no conflicts of interest.
Journal of Medical Case Reports
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