Monocytosis and Multiple Myeloma: treatment-related acute leukaemia?

• Published in: Surgical and experimental pathology 2022-04, Vol.5 (1), p.1-10, Article 8
• Main Authors: Trinidad Esparza, Cristina Veronica, Lizardo-Thiebaud, Maria J., Leal-Gutierrez, María Graciela, Sánchez-Hernandez, Beatriz, Montante Montes de Oca, Daniel
• Format: Article
• Language: English
• Subjects: Alkylating agents; Anemia; Biopsy; Bone marrow; Bortezomib; Chemotherapy; Disease; Drug dosages; Hematology; Industrialized nations; Infections; Leukaemia; Leukemia; Leukopenia; Multiple myeloma; Patients; Plasma; Serology; Stem cells; Steroids; Transplants & implants; Tumors
• ISSN: 2520-8454; 2520-8454
• DOI: 10.1186/s42047-022-00110-0

BackgroundTherapy-related acute monocytic leukemias in patients with plasma cell dyscrasias are infrequent.Case presentationWe here present a case of a 60 year old female who developed an acute monocytic leukemia two years after the diagnosis of multiple myeloma. She was treated with an alkylating agent and bortezomib before undergoing a hematopoietic stem cell transplantation. She suffered of multiple severe infections until her immune system was adequately reconstituted. A year afterwards, she presented signs of deterioration unrelated to the MM, with pancytopenia. The bone marrow aspirate failed to show a prominent blast population. The diagnosis of AML was confirmed after a bone marrow biopsy.DiscussionThe development of acute leukaemia after treatment for multiple myeloma is a well characterized phenomenon. Most frequently, patients develop a myelomonocytic leukemia. Similarly, synchronous acute myeloid leukemias are myelomonocytic or myeloblastic. Rarely synchronous AMLs are monocytic. The development of such suggests a dysfunctional bone marrow microenvironment.