Summary:We report a case of a patient with IgA multiple myeloma (MM) mobilized with etoposide and subsequently receiving high-dose melphalan (HDM) with stem cell support. She relapsed rapidly post transplantation. Southern blot and fluorescent in situ hybridization analysis showed MLL gene rearrangement in the myeloma cells, which was not detected in the sample at diagnosis or in the PBSC harvested with etoposide plus G-CSF. shown to be an effective and safe method for peripheral blood stem cell harvests (PBSCH), and an effective agent in tumor reduction in patients with malignancies. 2 Therefore, HDT and PBSC transfusion (PBSCT) is a common therapy for hematological malignancy, including MM. However, with improvements in survival following intensive chemotherapy, post-transplant therapy-related hematological malignancies are emerging as serious long-term complications. 4-6We described here a MM patient (IgA : stage IIIa) who received PBSCH using etoposide and G-CSF who was then given PBSCT after HDT with melphalan. At 40 days post-PBSCT, aggressive neoplastic myeloma cells were increased in her BM, and moreover MLL gene rearrangement was detected in these cells. This is the first report that etoposide for stem cell priming in a MM patient may cause secondary MLL gene abnormalities in neoplastic plasma cells. Case reportIn March 1999, a 54-year-old female was referred to hospital for hypergammaglobulinemia. She had a punched-out lesion in the skull. Her IgA level was 4800 mg/dl with values of 343 mg/dl IgG and 9.9 mg/dl IgM. Immunoelectrophoresis showed M-but not Bence-Jones proteins. BM examination showed hypercellularity with 95% neoplastic plasma cells (Figure 1a). These neoplastic plasma cells expressed CD20, CD38, and IgA but not CD19 on their surface. The patient was diagnosed with IgA MM
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