A case of acute myeloid leukemia and multiple myeloma is observed to occur simultaneously
Shanfeng Hao1, Yingqi Li2, Huaquan Wang1
1Department of Hematology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China.
Rationale:
Cases of acute myeloid leukemia occurring simultaneously with multiple myelomas are rare. To date, only 31 cases have been reported worldwide. The prognosis of these patients is very poor, and it is very important for them to be diagnosed promptly and treated effectively.
Patient Concerns:
A 68-year-old male patient was admitted due to the presence of intermittent nosebleeds accompanied by fever for 10 days, in addition to the development of a right neck mass over 3 days.
Diagnoses:
Diagnosis of acute monocytic leukemia (high-risk group) was based on morphology, immunophenotyping, histochemical staining, and chromosomal and genetic test results. The patient's chromosomes were found to be normal, yet next-generation sequencing revealed a TP53 mutation, thus classifying the risk stratification as high risk. The diagnosis of multiple myeloma was diagnosed based on the presence of > 10% myeloma cells and bone marrow biopsy findings suggestive of multiple myeloma.
Interventions:
Azacitidine 100 mg subcutaneous injection on days 1 to 7, in conjunction with hydrocortisone 50 mg every 12 hours, to treat acute myeloid leukemia in conjunction with multiple myeloma. During this course of treatment, the patient was administered anti-infectious therapy.
Outcomes:
The patient developed a brain abscess during treatment and passed away 2 months after hospitalization.
Lessons:
The patient's disease was severe and rapidly progressive, and comorbid severe infections and consistent comorbid severe pancytopenia posed challenges in managing this disease. It is hoped that more effective targeted therapies can be explored for such patients.
Insights
This rare case highlights the poor prognosis of simultaneous acute myeloid leukemia and multiple myeloma. Aggressive disease and complications led to a fatal outcome despite treatment.
Area of Science:
- Hematology
- Oncology
Background:
- Simultaneous occurrence of acute myeloid leukemia and multiple myeloma is exceptionally rare, with only 31 cases reported globally.
- Patients with these co-occurring hematologic malignancies face a very poor prognosis.
- Prompt diagnosis and effective treatment are critical for improving outcomes.
Purpose of the Study:
- To report a rare case of concurrent acute myeloid leukemia and multiple myeloma.
- To discuss the diagnostic and therapeutic challenges associated with this dual diagnosis.
- To emphasize the need for novel therapeutic strategies.
Main Methods:
- A 68-year-old male presented with epistaxis, fever, and a neck mass.
- Diagnosis involved morphology, immunophenotyping, histochemistry, and genetic testing, revealing high-risk acute monocytic leukemia with a TP53 mutation and multiple myeloma.
- Treatment included azacitidine, hydrocortisone, and anti-infectious therapy.
Main Results:
- The patient was diagnosed with high-risk acute monocytic leukemia and multiple myeloma.
- Treatment was initiated with azacitidine and hydrocortisone.
- A brain abscess developed during treatment, leading to the patient's demise two months post-hospitalization.
Conclusions:
- The patient's disease was severe and rapidly progressive.
- Comorbid severe infections and pancytopenia presented significant management challenges.
- Further research into targeted therapies is crucial for this patient population.
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