Secondary plasma cell leukaemia (PCL) with plasmablastic morphology

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Multiple myeloma is a plasma cell malignancy.
• Relapsed myeloma can undergo transformation into more aggressive forms.
• Secondary plasma cell leukemia (PCL) presents a significant clinical challenge.

Observation:

• A 71-year-old female with relapsed IgA lambda myeloma presented with progressive cytopenia.
• Peripheral blood revealed 5% blastoid cells, and flow cytometry indicated plasma cells.
• Bone marrow examination showed extensive plasmablasts, confirmed as myeloma without acute leukemia.

Findings:

• Genetic analysis revealed a complex genome with high-risk mutations via FISH and NGS.
• The patient was diagnosed with plasmablastic progression of myeloma and secondary PCL.
• This subtype is associated with a poor prognosis.

Implications:

• Accurate diagnosis of secondary PCL is critical for patient management.
• There is a need to investigate novel therapeutic strategies for this aggressive myeloma subtype.
• Understanding the genomic landscape aids in risk stratification and treatment selection.