ABSTRACT
Concurrences of multiple myeloma with myeloproliferative diseases or secondary myeloid leukemoid reactions are rather rare. The paper describes 3 cases of multiple myeloma: the first case concurrent with neutrophilic leukocytosis; the second case with secondary erythropoetin-dependent erythrocytosis, and the third case with chronic myeloid leukemia. In such cases, an accurate diagnosis requires molecular testing, besides routine clinical and laboratory studies. The paper discusses therapeutic strategy in cases of a concurrence of 2 competing tumors of the blood system: to treat them simultaneously or the most aggressive tumor now, as well as a relationship between multiple myeloma and chronic myeloid leukemia, other myeloproliferative disorders, and secondary myeloid leukemoid reactions.
Subject(s)
Leukemia, Myeloid/diagnosis , Leukocytosis/diagnosis , Multiple Myeloma/diagnosis , Myeloproliferative Disorders/diagnosis , Polycythemia/diagnosis , Adult , Comorbidity , Female , Humans , Leukemia, Myeloid/epidemiology , Leukemia, Myeloid/therapy , Leukocytosis/epidemiology , Leukocytosis/therapy , Middle Aged , Multiple Myeloma/epidemiology , Multiple Myeloma/therapy , Myeloproliferative Disorders/epidemiology , Myeloproliferative Disorders/therapy , Polycythemia/epidemiology , Polycythemia/therapyABSTRACT
Extramedullary disease is an uncommon manifestation in multiple myeloma (MM) and can be observed at onset or develop at disease progression or relapse. Splenic involvement is very rare. The paper describes a 52-year-old female patient with MM who in 1990 was diagnosed with monoclonal gammopathy of undetermined significance with IgGkappa secretion and a considerably enlarged spleen. Specific therapy with bortezomib and dexamethasone was initiated in 2006 and proved to be inefficient. After splenectomy there was a 50% reduction in IgGkappa concentration. Splenic histological examination revealed monoclonal infiltration by the pleomorphic plasma cells expressing a kappa light chain.