ALL After Multiple Myeloma: Clonally Related or Not?
Posted: Friday, August 31, 2018
Patients who survive multiple myeloma may develop secondary primary malignancies, especially myelodysplastic syndrome and acute myeloid leukemia at a rate of up to 11 times higher than that of the general population. Ibrahim Aldoss, MD, of Gehr Family Center for Leukemia Research, City of Hope, Duarte, California, and colleagues sought clues to understand why acute lymphoblastic leukemia (ALL) is much less common among the secondary myeloid neoplasms usually observed. Their research and conclusion—that ALL, when it does develop, may be related to treatment rather than clonally related—were published in the journal Leukemia.
“Both multiple myeloma and the majority of ALL are of B cell origin…[raising] the question of whether ALL in patients with multiple myeloma arises from the same clone,” the authors wrote. They studied 13 cases of B-cell ALL that had onset in patients with multiple myeloma 3.3 to 10 years after their initial diagnosis. The patients’ median age at ALL diagnosis was 60 years. All patients had received immunomodulatory agents to treat their multiple myeloma; 10 patients had had autologous hematopoietic cell transplantation as well.
“ALL genetics showed a normal karyotype, TP53 mutation/deletion, and monosomy 7 or 7q deletion in 5, 3, and 2 cases, respectively,” noted Dr. Aldoss and colleagues. Furthermore, “analysis of paired samples of [multiple myeloma] and ALL using whole exome sequencing demonstrated that the malignancies arose from different clones.”
Research in this area is especially significant, as multiple myeloma survival continues to improve, noted the team.
