Multiple Myeloma and Chronic Lymphocytic Leukemia in a Single Individual

Hoffmann, Klaus D.; Rudders, Richard A.

doi:10.1001/archinte.1977.03630140080016

Cited by 29 publications

(5 citation statements)

References 14 publications

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“…In those cases where clonality studies were performed, the investigations have consisted of analysis of immunoglobulin isotypes, light chain restrictions, and idiotypes. Based on these types of immunologic studies, most instances of this uncommon association of MM with a second B-cell neoplasm have been characterized as the coexistence of two separate neoplastic clones (2)(3)(4)(5)(6). Occasionally, the clonal relationship of the two neoplasms has remained undetermined (7).…”

Section: Introductionmentioning

confidence: 99%

Separate clones in concomitant multiple myeloma and a second B‐cell neoplasm demonstrated by molecular and immunophenotypic analysis

Novak

Mattson

Crisan

et al. 1995

European J of Haematology

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The occurrence of multiple myeloma (MM) and a second B‐cell neoplasm in the same patient is a rare event. We present 2 such patients, and provide evidence to support the presence of separate clones in these coexisting neoplasms. In the first case, MM became evident 14 months after the diagnosis of chronic lymphocytic leukemia (CLL). In past reports, most occurrences of this association, when investigated, have been regarded to be biclonal disease processes; however, with few exceptions, most were documented by immunologic studies alone. To establish the clonality in our case of CLL with MM, we examined both immunophenotypic data obtained by standard two‐color flow cytometric analysis, and patterns of immunoglobulin gene rearrangement, using standard Southern analysis and hybridization with 32P‐labelled JH and JK probes. This provided evidence for the presence in this patient of two separate monoclonal populations of B cells, manifested as light chain restrictions and gene rearrangements which differed in blood (CLL) and bone marrow (MM) samples. In the second case, MM presented simultaneously with bone marrow lymphocytosis and abnormal peripheral lymphocytes. Clonality studies on blood were not done. Bone marrow B‐cell gene rearrangement studies, however, revealed the presence of three bands in the JK blot of significantly different intensities, suggestive of two monoclonal populations. A monoclonal population of small cells with surface B markers and surface IgM was demonstrated by flow cytometry, while a second population of larger cells with intracytoplasmic IgG matching the patient's serum monoclonal protein was detected by immunofluorescence microscopy. The results in these 2 cases expand previous findings of the rare association of MM with a second B‐cell neoplasm, and demonstrate the usefulness of molecular diagnostic investigation.

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Section: Introductionmentioning

confidence: 99%

Separate clones in concomitant multiple myeloma and a second B‐cell neoplasm demonstrated by molecular and immunophenotypic analysis

Novak

Mattson

Crisan

et al. 1995

European J of Haematology

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“…Prolonged immunosuppression in CLL patients, especially those treated with purine analogs, may increase the risk of secondary malignancies (9–14). To our knowledge, PBL has not been reported in CLL, but the coexistence of MM with CLL was observed (15–26). Either both malignancies were diagnosed simultaneously (21–25) or CLL developed after the occurrence of MM (26).…”

mentioning

confidence: 98%

Plasmablastic lymphoma in a patient with chronic lymphocytic leukemia heavily pretreated with cladribine (2‐CdA): an unusual variant of Richter's syndrome

Robak¹,

Urbańska-Ryś²,

Strzelecka³

et al. 2001

European J of Haematology

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Patients with chronic lymphocytic leukemia (CLL) may develop a large-cell transformation known as Richter's syndrome (RS). RS usually presents as diffuse large-cell lymphoma (DLCL) or its immunoblastic variant, and it can be recognized simultaneously with CLL or even 23 yr after its diagnosis. We describe an unusual case of CLL treated with cladribine (2-CdA) in whom DLCL of the plasmablastic type (PBL) developed 4 yr after CLL (Rai IV) diagnosis and 1.5 yr after the 10th course of 2-CdA treatment. Immmunologic, cytogenetic, and molecular studies performed at the time of CLL and PBL coappearance indicated that both tumors originated from different B-cell progenitors. Both malignancies were refractory to VAD (vincristine, doxorubicin, dexamethasone)-based chemotherapy, and only partial response was achieved with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) salvage treatment. However, the patient died 6 months after the occurrence of RS due to rapid progression of PBL. This is the first description of a CLL patient who developed an unusual plasmablastic variant of RS. Recently, the PBL entity has been identified among DLCL associated with the human immunodeficiency virus (HIV) infection. We suggest that in our CLL patient heavily pretreated with 2-CdA, PBL arose as a second clone due to the prolonged and severe state of the host's immunosuppression. Overall survival with current strategies is poor, and further insight into the natural history, biology, and treatment of PBL are needed.

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“…2 Coexistence of two separate malignancies, which was likely in this patient, was reported by Hoffmann and Rudders. 11 The discovery of MM in a 68-yearold patient was similar to this patient, in that both patients experienced back pain and had an enlarged spleen while having asymptomatic CLL. However, the patient in Hoffmann and Rudders' report progressed rapidly despite chemotherapy and radiation therapy, experienced lytic lesions and compression fractures of the bone and, shortly thereafter, death.…”

Section: Discussionmentioning

confidence: 52%

“…However, the patient in Hoffmann and Rudders' report progressed rapidly despite chemotherapy and radiation therapy, experienced lytic lesions and compression fractures of the bone and, shortly thereafter, death. 8,11 Frequently, CLL and MM are reported simultaneously or CLL precedes MM, and only rarely does CLL present after MM. 8 In 1985, it was shown that 20 of 35 reported patients were diagnosed with MM 2 to 15 years after the diagnosis of CLL.…”

Section: Discussionmentioning

confidence: 99%

Chronic Lymphocytic Leukaemia and Multiple Myeloma

Pulenzas¹,

Porwit²,

Craddock³

et al. 2014

Hong Kong J Radiol

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Association of chronic lymphocytic leukaemia and multiple myeloma in the same individual is rare. These malignancies may be related through a common clonal origin, or exist as separate malignancies from different clones. Multiple myeloma may exist simultaneously with chronic lymphocytic leukaemia, or be diagnosed several months after chronic lymphocytic leukaemia. Common symptoms experienced in these rare cases are generally a combination of clinical features typically seen in chronic lymphocytic leukaemia and multiple myeloma separately. This report describes a 76-year-old man with coexisting chronic lymphocytic leukaemia and multiple myeloma. Diagnosis of chronic lymphocytic leukaemia preceded the diagnosis of multiple myeloma by approximately 4 years, and multiple myeloma presented with translocation t(11;14) that was not found in chronic lymphocytic leukaemia cells.

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Multiple Myeloma and Chronic Lymphocytic Leukemia in a Single Individual

Cited by 29 publications

References 14 publications

Separate clones in concomitant multiple myeloma and a second B‐cell neoplasm demonstrated by molecular and immunophenotypic analysis

Separate clones in concomitant multiple myeloma and a second B‐cell neoplasm demonstrated by molecular and immunophenotypic analysis

Plasmablastic lymphoma in a patient with chronic lymphocytic leukemia heavily pretreated with cladribine (2‐CdA): an unusual variant of Richter's syndrome

Chronic Lymphocytic Leukaemia and Multiple Myeloma

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