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Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
Published on: November 26, 2018
Case Report: IgG multiple myeloma and chronic myeloid leukemia in a single patient
Neeraja Swaminathan1, Sorab Gupta2, Claudia Dourado2
1Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, 19141, USA.
Insights
This case report details a rare instance of chronic myeloid leukemia (CML) and multiple myeloma (MM) co-occurring in one patient. It highlights the challenges and management of treating these two distinct hematological malignancies simultaneously.
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm.
- Monoclonal gammopathy of undetermined significance (MGUS) can progress to multiple myeloma (MM).
- The co-occurrence of CML and MM is exceptionally rare.
Observation:
- A 58-year-old man with CML in remission due to imatinib non-compliance experienced recurrence.
- The patient also had IgG kappa MGUS, which progressed to smoldering myeloma and then MM.
- He achieved molecular remission for CML while undergoing treatment for MM.
Findings:
- The patient successfully managed both CML and MM concurrently.
- Treatment involved imatinib for CML and a combination of thalidomide, bortezomib, and dexamethasone for MM.
- The patient is currently being evaluated for a bone marrow transplant.
Implications:
- This case underscores the possibility of managing two concurrent hematological malignancies.
- It prompts further investigation into the pathophysiology linking CML and MM.
- Understanding these associations is crucial for optimizing treatment strategies and patient outcomes.
Abstract:
A 58-year-old man presented with recurrence of chronic myeloid leukemia (CML) after complete molecular remission in the setting of non-compliance with imatinib. He was restarted on imatinib and was also noted to have IgG kappa monoclonal gammopathy of undetermined significance (MGUS). The patient re-achieved molecular remission after resumption of imatinib, but his MGUS progressed to smoldering myeloma and he was eventually diagnosed with multiple myeloma (MM) and initiated on treatment for MM with thalidomide, bortezomib and dexamethasone. He has responded well to treatment of the myeloma and continues concurrent maintenance imatinib treatment for CML and is being evaluated for bone marrow transplant. The association of two concurrent hematological malignancies, CML and MM, is very rare and has been infrequently reported in literature. The pathophysiology of this has not yet been fully understood. This case report reviews the various theories to explain this and discusses the potential challenges of simultaneous treatment of MM and CML.
