An unusual case of chronic lymphocytic leukemia, multiple myeloma and cardiac amyloidosis

Abstract

Light chain amyloidosis has very rarely been reported in association with chronic lymphocytic leukemia (CLL). We reported on a 76-years-old female who presented with simultaneous kappa-restricted chronic lymphocytic leukemia (CLL) and a lambda-restricted multiple myeloma with plasma cells causing AL amyloidosis involving the heart. While monoclonal immunoglobulins occasionallyproduced by CLL have previously been implicated in AL amyloidosis, there only a few cases reported of AL amyloidosis resulting from a distinct plasma cell dyscrasia that is not clonally related to the concurrent CLL.

Near tetrapoloid karyotype with translocation t(11;14) in a Moroccan patient with amyloid light-chain amyloidosis and multiple myeloma

“…AL is a systemic disorder characterized by widespread deposition of amyloid fibrils derived from monoclonal immunoglobulin light chains in organs and soft tissues. AL is typically caused by an underlying plasma cell clone disorder and occurs in 6–15% of patients with MM [13] .…”

Multiple Faces of Chronic Lymphocytic Leukaemia: A Patient with Renal, Cardiac, and Skeletal Complications

“…Multiple potential mechanisms have been suggested including leucocyte aggregation and adhesion with vessel plugging, activation of the coagulation system, interaction with platelets to promote thrombin generation, increased expression of monocyte and neutrophil tissue factors, and release of soluble mediators such as proteases, reactive oxygen species, growth factors, interleukins, and myeloperoxidase [ 16 – 18 ]. Patients with CLL may also develop amyloid infiltration of the heart, either paraprotein-related AL amyloid [ 19 ] or, less commonly, non-AL; the latter group appears to have a better prognosis [ 20 ]. Amyloid can also deposit within vessels causing occlusion [ 21 ].…”