Secondary Plasma Cell Leukemia in a Recurrent Multiple Myeloma: Rare Case Scenario

Area of Science:

• Hematology
• Oncology

Background:

• Plasma cell leukemia (PCL) is an aggressive hematological malignancy.
• It can present as primary or secondary to multiple myeloma (MM).

Observation:

• A 79-year-old patient with a history of MM developed secondary PCL.
• Peripheral smear analysis revealed atypical plasma cells with kappa restriction and dim CD138 expression.
• The patient experienced central nervous system (CNS) involvement confirmed by MRI and cerebrospinal fluid analysis.

Findings:

• Initial treatment with brentuximab vedotin led to near elimination of peripheral plasma cells.
• Despite initial response, the patient developed CNS disease, necessitating whole brain radiation and ibrutinib.
• The case illustrates a rare, aggressive clinical course involving kidney plasmacytoma and CNS metastasis.

Implications:

• This case underscores the importance of vigilant monitoring for CNS involvement in aggressive MM and PCL.
• It highlights the complex treatment strategies required for advanced hematological malignancies.
• Understanding rare presentations is crucial for improving patient outcomes in plasma cell disorders.