Myeloma in a Case of Hodgkin’s Disease

Abstract

This report describes the clinical and pathological features of a case of nodular sclerosing Hodgkin’s disease treated with a variety of chemotherapeutic agents who developed fulminating IgG myeloma approximately 26 months after the initial diagnosis of Hodgkin’s disease. The possible significance of this association is discussed in relation to the previous literature concerning the development of a second malignancy in Hodgkin’s disease.

Simultaneous Occurrence of Myeloma and Hodgkin’s Disease

“…[2] observed a 3.5-fold increase in the risk of developing a second malignancy in all patients, with the greatest risk (29-fold) in a group of 35 patients who had received both intensive radiotherapy and intensive chemo therapy. The spectrum of second malignancies in Hodgkin's patients is broad [4,10,13], acute leukemia having been particularly emphasized [5,II,12,14], The increased incidence of second neoplasms in Hodgkin's patients has been attributed to the cellular immune deficiency associated with the disease as well as the immunosuppressive effects of radiotherapy and chemotherapy.…”

“…The coexistence of Hodgkin's disease and multiple myeloma has only been reported in three patients [4,7]. In each of these instances, myeloma was diagnosed after either irradiation or chemotherapy had been given for the Hodgkin's disease, raising the possibility that myeloma may heve been induced, or precipitated, by these therapeutic interventions.…”

Solitary Plasmacytoma of the Bone in a Case of Hodgkin’s Disease

“…It has previously been described in 4 cases only [4,5,8]. In all of them, both the serum M component and a signi ficant infiltration of plasma cells in the bone marrow supported the diagnosis of overt MM.…”

“…In accordance with our findings, also the cases reported both by Sacks et al [8], in which MM and HD occurred simultaneously and prior to any treatment, and by Greenberg et al [5], in which the diagnosis of MM was made soon after radiation th e r a p y f o r H D , se e m to s u p p o r t th e h y p o th e s is th a t myelomatosis may be unrelated to any previous im munosuppressive therapy. On the other hand, the ob servation by Cawley et al [4] of overt MM following combined chemotherapy for HD with alkylating agents, vinka alkaloids and procarbazine, made it tempting to implicate these drugs in the development of the second malignancy.…”

“…This report describes a case of solitary plasmacytoma of the bone which occurred in a 35-year-old male 3 years after mantle field irradiation for Hodgkin's disease, nodular sclerosing, stage 1 A. The possible sig nificance of this rare association is discussed.The association of Hodgkin's disease (HD) and overt multiple myeloma (MM) has hitherto been de scribed in a few cases only [4,5,8]. We here report an other case, in which solitary plasmacytoma of the bone developed 3 years after the initial diagnosis of HD, nodular sclerosing, stage IA.…”