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Lenalidomide-Associated Secondary B-Lymphoblastic Leukemia/Lymphoma-A Unique Entity
Sharon Koorse Germans1, Ozlem Kulak1, Prasad Koduru2
1Department of Pathology, University of Texas Southwestern Medical Center, Dallas.
American Journal of Clinical Pathology
|September 4, 2020
Summary
Lenalidomide maintenance after stem cell transplant for multiple myeloma can lead to secondary B-lymphoblastic leukemia/lymphoma (B-ALL). Early B-ALL detection requires careful evaluation due to subtle presentation, with relapse indicating complex genetic changes.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Autologous stem cell transplant (ASCT) with lenalidomide maintenance improves outcomes for multiple myeloma (MM).
- ASCT with lenalidomide is associated with an increased risk of secondary B-lymphoblastic leukemia/lymphoma (B-ALL).
Observation:
- This review details the clinicopathologic features of two patients who developed secondary B-ALL during lenalidomide maintenance therapy for MM.
- Secondary B-ALL presented with subtle clinical, morphologic, and flow-cytometric findings, potentially mimicking hematogones.
Findings:
- Both patients achieved complete remission with chemotherapy, but one has minimal residual disease and the other relapsed.
- Next-generation sequencing of the relapse specimen revealed complex genetic abnormalities, suggesting clonal evolution.
Implications:
- Increased awareness of secondary B-ALL in MM patients on lenalidomide maintenance is crucial.
- Further research is needed to understand and manage this complication effectively.
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