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[Multiple myeloma in a patient in remission from malignant lymphoma]
S Hashimoto1, E Kawano, A Hirasawa
1Division of Blood Transfusion, Chiba University Hospital.
Insights
This case report details a rare instance of multiple myeloma developing after treatment for diffuse, large cell malignant lymphoma. Both B-cell malignancies exhibited kappa light chain characteristics, suggesting a potential link in tumor cell origin.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Malignant lymphoma and multiple myeloma are distinct B-cell neoplasms.
- The co-occurrence of these two conditions is exceptionally rare.
- Understanding the relationship between different B-cell malignancies is crucial for diagnosis and treatment.
Observation:
- A 71-year-old male initially presented with diffuse, large cell malignant lymphoma (B-cell, IgG kappa type).
- Following successful treatment with the CHOP regimen, he achieved complete remission.
- Two years later, he developed monoclonal gammopathy, leading to a diagnosis of multiple myeloma (IgA kappa type).
Findings:
- This case represents the first documented instance of multiple myeloma arising subsequent to malignant lymphoma.
- Both neoplastic conditions in this patient shared kappa light chain expression.
- Bone marrow examination revealed a significant increase in plasma cells during the multiple myeloma phase.
Implications:
- This unique case suggests a potential shared clonal origin or a transformation pathway between malignant lymphoma and multiple myeloma.
- The consistent kappa light chain expression in both B-cell neoplasias provides a key characteristic for further investigation.
- Further research into such associations may elucidate the complex pathogenesis of B-cell malignancies and inform diagnostic and therapeutic strategies.
Abstract:
A 71-year-old man was admitted because of right cervical lymph node swelling in February 1986. Lymph node biopsy revealed that he suffered from diffuse, large cell malignant lymphoma. Immunological staining showed lymphoma characterized by B cell markers, IgG, kappa type. Bone marrow aspiration, revealed no evidence of lymphoma and 0.2% plasma cells. The clinical stage was IIA. The patient was treated with the CHOP regimen (doxorubicin, cyclophosphamide, vincristine and prednisolone), which achieved complete remission. In October 1988, he was re-admitted because of a subcutaneous abscess, and biopsy of the inguinal lymph node showed reactive lymphadenitis. Although he improved with antibiotic therapy, laboratory date on admission showed monoclonal gammopathy. Serum immunoelectrophoresis demonstrated a monoclonal bow of IgA kappa type, and bone marrow aspiration revealed hypercellularity with an increased number of plasma cells (76.8%). The patient was diagnosed as having multiple myeloma, and combination chemotherapy was begun. He now attends the out-patient department at our hospital. The development of multiple myeloma has not been reported previously during a course of malignant lymphoma. Although the association of these two B cell neoplasias was unknown, in this case both showed the characteristic of kappa type light chains. This case may provide information concerning tumor cell origin.