A Rare Presentation of Multiple Myeloma as a Second Primary Cancer Sequential to Non-Hodgkin Lymphoma: Case Report

The sequential occurrence of diffuse large B-cell lymphoma (DLBCL) a common type of non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM) is exceedingly rare, presenting a significant challenge in both diagnosis and treatment.

The case report discusses a 60-year-old male patient with a history of DLBCL which was diagnosed following symptoms of fever, weight loss and night sweats. He was treated with RVP (rituximab 375 mg/m², vincristine 1.4 mg/m², prednisolone 60 mg/m²) and R-CHOP regimen (rituximab 375 mg/m², cyclophosphamide 750 mg/m², doxorubicin 50 mg/m², vincristine 1.4 mg/m² and prednisolone 60 mg/m²), followed by autologous bone marrow transplantation. After a 7-year remission, the patient developed MM stage 3 as a second hematological malignancy. The presenting complaints include fatigue for a duration of 2 months along with shoulder pain, abdominal discomfort, anorexia, constipation, dry mouth, and feeling depressed. He was treated with six cycles of chemotherapy comprising bortezomib, lenalidomide, cyclophosphamide, and dexamethasone showing good tolerance collaterally. In addition, few supplementary treatments include denosumab for bone health and erythropoietin for anemia. Currently, the patient is on maintenance chemotherapy and concomitant radiation treatment for the management of MM, which are aimed at controlling disease progression and improving the quality of life.

This report highlights the case of a treated DLBCL which subsequently led to the rare development of new onset MM following a prolonged remission. It underscores the importance of long-term surveillance and effective management toward addressing the sequential hematological malignancies.