Rare Case of CML After Stem Cell Transplantation in Patient With Multiple Myeloma
Posted: Wednesday, November 7, 2018
An unusual case of a patient diagnosed with chronic myeloid leukemia (CML) after successful treatment of multiple myeloma was recently highlighted in Blood Research. According to Aisling Barrett, MRCPI, of Beaumont Hospital, Dublin, and colleagues, the 39-year-old woman is the youngest recorded patient to have developed both diseases and the first reported patient to develop CML after autologous stem cell transplantation.
“The co-diagnosis of multiple myeloma and CML is a vanishing rare phenomenon, with literature on this topic confined to case reports and small series,” stated Dr. Barrett and colleagues.
The patient was first diagnosed with multiple myeloma after presenting with left hip pain due to a large lytic lesion in the neck of the femur. After induction chemotherapy, radiation therapy to the fracture site, and monthly bisphosphonate infusions, she received a melphalan-conditioned autologous stem cell transplant.
Two and a half years after the initial diagnosis, with her multiple myeloma in remission, the patient had a rising white blood cell count with elevated neutrophil and monocyte counts. The BCR-ABL ratio was elevated at 140.6%, and bone marrow composition was consistent with chronic-phase CML. The bone marrow karyotype confirmed the presence of an abnormal clone.
“Clonal expansion in both the lymphoid and the myeloid cell lineages is implied as pathology of the disease,” stated the authors. “Possible hypotheses for this include the development of a common malignant pluripotent hematopoietic stem cell, treatment-related toxicity of myeloid cells and environmental factors.”
After suboptimal response to imatinib therapy, treatment with nilotinib was initiated, resulting in an improved molecular response. The patient’s CML and multiple myeloma are both currently in remission.
