Simultaneous Presentation of Waldenstr^|^ouml;m Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

Abstract

Waldenström macroglobulinemia and multiple myeloma are mature B-cell neoplasms deriving from post-germinal cells at different stages of differentiation. The simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma in the same patient is a very rare phenomenon and, so far, only two cases have been described. We report the case of a 75-year Caucasian female patient, with a silent clinical history, who presented with anemia and two different monoclonal proteins (IgMk and IgGk). The trephine biopsy showed the presence of a dual population, represented by small lymphoplasmacytoid cells and by plasma cells, which infiltrated the bone marrow with a clearly different pattern. Both immunohistochemistry and flow cytometry demonstrated the biclonal origin such neoplastic cells, since lymphoplasmacytoid cells resulted IgMk while plasma cells were IgGk. This biclonal pattern was further confirmed by the demonstration of a different IgH gene rearrangement of the two neoplasms. The patient was treated with bortezomib, dexamethasone and rituximab, achieving partial remission of both Waldenström macroglobulinemia and multiple myeloma. After a 30-month follow-up, she is in stable disease. Multiple myeloma has been described in association with other indolent B-cell neoplasms, mostly chronic lymphocytic leukemia, while Waldenström macroglobulinemia can be followed by diffuse large B-cell lymphoma in some instances, after chemotherapy. The association of Waldenström macroglobulinemia and multiple myeloma seems to be very rare. Our study shows that an integrated diagnostic work-up is very useful in such cases, with an interesting role for flow cytometry. 〔J Clin Exp Hematop 53(1): 29-36, 2013〕

Modifications in B-Lymphocyte Number and Phenotype in the Course of Pregnancy in a Woman with Persistent Polyclonal B-Cell Lymphocytosis: A Flow Cytometric Study

“…Lymphocytes were gated using CD45 expression and right angle scatter, and 100,000 events/tube were acquired. 15,16 Immunophenotyping of peripheral blood showed a high percentage of B-lymphocytes (60%; absolute number: 3.6 × 10 9 /L), positive for CD19, CD20, CD22, CD79b, and with polyclonal expression of surface immunoglobulin k and l light chains (ratio: 1.2). Most of B-lymphocytes (72%; absolute number: 2.59 × 10 9 /L) showed the immunophenotype of central memory cells (CD27 + , IgD + , IgM + ), while a lower percentage of naïve B-lymphocytes (27%; absolute number: 0.97 × 10 9 /L) was found (Fig.…”

Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient

“…Even though chronic lymphocytic leukemia (CLL) and multiple myeloma are individually quite common, there are very few published reports of concomitant presence of CLL and multiple myeloma in the same patient [1][2][3][4][5][6]. This diagnosis has to be carefully differentiated from small B cell lymphomas showing plasma cell differentiation, splenic marginal zone lymphoma with plasmacytic differentiation and chronic lymphocytic leukemia with plasmacytic differentiation [1].…”