Occurrence of Metachronous Multiple Myeloma in an Elderly Patient with Chronic Myeloid Leukemia in Treatment Free-Remission: A Case Report and Review of the Literature
Abstract
Background: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of Philadelphia chromosome t(9;22) (q34;q11). Multiple myeloma (MM) is a clonal plasma cell proliferation. The co-existence of CML and MM is rarely reported in medical literature, and its pathogenesis remains poorly understood. We describe the unusual presentation of a CML patient who developed MM after approximately ~15 years of CML diagnosis, currently in treatment free remission.
Methods: We retrospectively reviewed the clinical data, imaging studies, laboratory investigations including serum protein electrophoresis, and routine molecular monitoring. A detailed literature review of reported CML and MM co-occurrences was also conducted. Informed patient consent was obtained.
Results: A 73-year-old male diagnosed with CML, currently in treatment-free remission (TFR) for the past 8 years, presented with new cardiac and spinal symptoms. A detailed diagnostic evaluation, including laboratory tests and imaging, revealed features of plasma cell dyscrasia, establishing a definitive diagnosis of metachronous MM. Bone marrow core biopsy, bone marrow aspirate reveled 35% to 40% plasma cells and 23% plasma cells, respectively. The immune-histochemistry was positive for CD38+, CD138+, CD56+, Beta-2 microglobulin (?2M) +, Kappa Light Chain.
Conclusion: In conclusion, this case elucidates the development of a second primary hematologic malignancy during extended CML treatment-free remission. It highlights the necessity of continuous comprehensive clinical investigation beyond routine BCR-ABL1 testing and suggests that monitoring serum protein electrophoresis may be clinically valuable in long-term TKI-treated patients.
Keywords
Immunoglobulin G, Multiple myeloma, Chronic myeloid leukemia, Bortezomib, Lenalidomide, Imatinib
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DOI: https://doi.org/10.62940/als.v13i3.4020
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