Three Patients with Multiple Myeloma Developing Secondary Lymphoblastic Leukemia: Case Reports and Review of the Literature

Abstract

Multiple immune defects caused by exposure to a variety of agents can play an important role in the development of secondary lymphoblastic leukemia. Microscopic morphology and flow cytometry are important means to detect secondary malignancies in multiple myeloma. Further clinical, experimental and genetic studies of secondary malignancies in multiple myeloma will be necessary in the future.

Secondary lymphoblastic leukemia occurring 38 months after the primary diagnosis of multiple myeloma: A case report

“…In the reported cases, the majority of secondary malignancies in MM were acute myelocytic leukemia (AML), myelodysplastic syndrome (MDS) and solid tumors ( 4 – 7 ). In a previous study, the present authors reported 3 cases of MM who developed lymphoblastic leukemia after exposure to a variety of agents ( 9 ). The present study reports the case of a patient who developed secondary lymphoblastic leukemia 38 months after the initial MM diagnosis.…”

“…A very low percentage of similar blast cells were found in the bone marrow smears during maintenance therapy in all those 3 cases ( 9 ). It is not known whether the subsequent occurrence of secondary B-cell lymphoblastic leukemia represents a transformation of MM into a less differentiated B-cell malignancy, a biclonal neoplasm arising from an oncogenic event in a common B-cell precursor, or an independent oncogenic event due to the defect in immune dysregulation ( 4 , 6 – 9 ). However, if a low percentage of blast cells is noticed early on, flow cytometry may be introduced and provide further evidence of disease, and the patient may also have a chance for early intervention.…”

“…The present authors previously reported 3 cases of MM who developed lymphoblastic leukemia after exposure to a variety of agents ( 9 ). The present study reports the case of a patient who developed B-cell lymphoblastic leukemia 38 months after the initial diagnosis of MM.…”

Therapy-related B-lymphoblastic leukemia after multiple myeloma

“…We report our institution's experience with eight patients diagnosed with t-B-ALL or incipient t-B-ALL in the setting of therapy for MM, including lenalidomide maintenance therapy. While therapy-related malignancies in this setting are far more commonly myeloid neoplasms [13] , recent reports of t-B-ALL in the literature reflect increasing recognition of this entity [ 10 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ]. t-B-ALL is rare or under-recognized, with <50 reported cases to our knowledge individually or in small series, and additional cases described within larger analyses [ 30 , 31 ] Table 2 .…”

Myelodysplastic Syndrome Secondary to Multiple Myeloma: A Case Report and Literature Review

“…large number of literatures have reported that the risk of secondary hematological tumors in tumor patients is significantly higher than that in ordinary people[3] [4][5]. In recent years, with the prolongation of the survival time in MM patients, the incidence rate of MM related second tumors was increased[6].Studies show that there is a causal relationship between the treatment of primary malignant tumors and the incidence of secondary tumors.…”