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Rare Case of Dual Multiple Myeloma and AML: Combination Therapy Active for Both

By: Joseph Fanelli
Posted: Thursday, May 28, 2020

A case study presented in Leukemia Research Reports related a rare synchronous diagnosis of a patient with multiple myeloma and acute myeloid leukemia (AML), and both cancers were treated simultaneously with a combination of drugs active in both diseases. Celine Berthon, MD, of the Centre Hospitalier Universitaire de Lille, France, and colleagues employed a combination of lenalidomide plus azacitidine and daratumumab, which resulted in reportedly the longest survival response for a patient with this combination of diseases to date.

“A rational design of new drug associations that are potentially active in both diseases should be considered in this very specific and rare clinical situation, where data from clinical trials are unlikely to become available,” the authors concluded.

The patient, a 68-year-old man, was first diagnosed with chronic myelomonocytic leukemia and high-risk multiple myeloma in April 2014. The following month, further tests revealed evidence of multiple myeloma and AML “co-evolving from precursor states.” 

The patient was treated with a regimen of lenalidomide and azacitidine as maintenance therapy for AML, after a 7+3 induction regimen as first-line therapy for multiple myeloma resulted in complete remission. The authors reported the lenalidomide/azacitidine regimen demonstrated efficacy for 40 months before progression of multiple myeloma. At that point, treatment with lenalidomide was discontinued and replaced with daratumumab, which was used in parallel with azacitidine.

After 15 more cycles, the patient’s AML relapsed. He then received two cycles of low-dose cytarabine combined with venetoclax but eventually died in May 2019 of leukemic progression. The patient’s total survival time from diagnosis was 55 months.

Disclosure: The authors reported no conflicts of interest.

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