Concurrent chronic neutrophilic leukemia blast crisis and multiple myeloma: A case report and literature review

Abstract

Abstract. The current study presents the case of a 78-year-old male with concurrent chronic neutrophilic leukemia (CNL) and multiple myeloma (MM) who developed acute myeloid leukemia after two years of treatment with hydroxyurea, cyclophosphamide, prednisone and thalidomide. The patient presented with mature neutrophilic leukocytosis, hepatosplenomegaly, a high neutrophil alkaline phosphatase score and an absence of the Philadelphia chromosome or the BCR-ABL fusion gene. A bone marrow aspirate smear and biopsy indicated that the CNL coexisted with a plasma cell neoplasm. In addition, monoclonal λ-paraproteinemia was detected by serum protein immunofixation electrophoresis, and bone lesions were identified in multiple vertebrae. The patient achieved complete remission following one cycle of induction chemotherapy with the decitabine regimen in combination with the low-dose cytarabine, aclarubicin and granulocyte-colony stimulating factor (CAG) priming regimen. The occurrence of CNL and MM concurrently is extremely rare and thus, it has only been reported in a small number of cases. The occurrence of CNL and MM in the same patient as two distinct hematological malignancies indicates the neoplastic transformation of a pluripotent stem cell. Decitabine combined with the CAG priming regimen may present a good therapeutic strategy for elderly patients with secondary acute myeloid leukemia.

The extremely rare chronic neutrophilic leukemia characterized by unrelieved abdominal distention and swollen painful limbs

“…In 2016, the WHO issued the diagnostic criteria for CNL, but it is frustrating that there is no international standard treatment plan and standard of care for the treatment of CNL. Many researchers have used hydroxyurea, interferon-α or splenectomy as rst-line treatments for the CNL patients, while the clinical effectiveness and remission rate are worrying [16][17]. Although CNL is a hematological malignancies, whether CNL patients can bene t from hematopoietic stem cell transplantation lacks su cient data and consensus among hematologists [5,8,18].…”

Multiple Myeloma with Neutrophilia: Two Etiologic Pathways for a Rare Presentation of a Common Diagnosis

“…As a bone marrow biopsy would be part of a typical workup for unexplained neutrophilia, specific evaluation for monoclonal plasma cells is an easy and efficient step for determining if neutrophilia is just the presenting symptom of a case of MM, which was true in both of our reported cases. Further, the literature shows several cases where a diagnosis of "CNL" preceded an alternate diagnosis of MM/MGUS with neutrophilia [4,5,[25][26][27][28]. As cases with neutrophilia secondary to MM can show marked granulocytic hyperplasia in the marrow, which would potentially make plasma cells inconspicuous, immunohistochemical stains and/or ISH to specifically identify the plasma cells should be performed.…”

<p>The Synchronous Presence of Multiple Myelomas and Other Primary Malignant Tumors: Case Series with Literature Review</p>

“…The abnormal expression of CEACAM6 is also closely related to tumor progression, recurrence, and prognosis. 16,17 Mutation of the MYC gene is very high in MM 18 and its high expression is also related to the invasiveness of breast cancer. In an experimental study performed on mice, the mutation of threonine 58, which encodes the MYC protein, to alanine was linked to the development of breast cancer and the mutation of serine 62 to alanine was found to reduce the incidence of breast cancer.…”