CLINICAL IMAGE
Coexistence of chronic lymphocytic leukemia and multiple myeloma, do the roots of these entities originate from the same place? Alparslan Merdin , Jale Yıldız, Mehmet Sinan Dal, Merih Kızıl C ß akar, Ali Hakan Kaya, € ndu € z & Fevzi Altuntasß Emre Tekgu Hematology Clinic and Bone Marrow Transplantation Unit, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
Correspondence Alparslan Merdin, Hematology Clinic and Bone Marrow Transplantation Unit, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey. Tel: 00903123360909-7216; Fax: 0090312 334 03 52; E-mail:
[email protected]
Key Clinical Message Multiple myeloma is a plasma cell disease, whereas CLL (Chronic Lymphocytic Leukemia) affects mature B-cell lymphocytes. Even though the coexistence of those two conditions is extremely rare, as both cell types differentiate from the same multipotent stem cells, the clinician should evaluate patients carefully not to misdiagnose such a concomitancy. Keywords
Funding Information No sources of funding were declared for this study.
Chronic lymphocytic leukemia, coexistent, multiple myeloma.
Received: 17 November 2016; Revised: 4 March 2017; Accepted: 14 March 2017
doi: 10.1002/ccr3.951
A 56-year-old male patient was admitted to hospital with severe anemia and lymphocytosis. Physical examination revealed splenomegaly and lymphadenopathy. Laboratory
Figure 1. Peripheral blood smear showing mature lymphocytes.
findings revealed lymphocyte: 45,670 mm³(1500–3500), beta-2-Mikroglobulin: 12.2 mg/L (0.7–1.8), calcium:
Figure 2. Bone marrow aspiration smear showing diffuse plasma cell infiltration.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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A. Merdin et al.
Coexistence of CLL and MM in a 56 year old male
11.6 mg/dL (8.4–10.2), creatinine: 0.89 mg/dL, serum, and urine kappa monoclonal gammopathy positivity. Flow cytometry analysis from peripheral blood (PB) detected CLL (Chronic lymphocytic leukemia); but from bone marrow (BM) aspiration detected MM (multiple myeloma). PB smear showed mature lymphocytes (Fig. 1). Besides, BM smear showed plasma cells (Fig. 2). Bone marrow biopsy showed 80% plasma cell infiltration. Coexistence of CLL and MM is an extremely rare clinical entity. Multiple myeloma is a disease of plasma cells. And CLL is a disease of mature B-cell lymphocytes. Clonal association in the coexistence of CLL and MM is controversial [1, 2]. But plasma cells differentiate from the lymphocytes. And further reports would shed light on this rare concomitant entity.
Authorship AM, JY, MSD, ET, FA: patient follow-up; AM, JY, MSD, MKC ß , AHK, ET, FA: drafting the article.
2
Conflict of Interest None declared.
Acknowledgments The abstract was presented as a poster in the 11th National Apheresis Congress, 2016, Turkey. Abstract no: O4 References 1. Saltman, D. L., J. A. Ross, R. E. Banks, F. M. Ross, A. M. Ford, and M. J. Mackie. 1989. Molecular evidence for a single clonal origin in biphenotypic concomitant chronic lymphocytic leukemia and multiple myeloma. Blood 74:2062–2065. 2. Pantic, M., P. Schroettner, D. Pfeifer, J. Rawluk, U. Denz, A. Schmitt-Gr€aff, et al. 2010. Biclonal origin prevails in concomitant chronic lymphocytic leukemia and multiple myeloma. Leukemia 24:885–890.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
