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Liberatore C, Fioritoni F, Natale A, Montanaro G, La Barba G, Passeri C, Iuliani O, Fabi B, Baldoni S, Fantasia D, Calabrese G, Accorsi P, Santarone S, Pulini S, Di Ianni M. Daratumumab-based induction and autologous transplantation in concomitant multiple myeloma and chronic myeloid leukemia. EJHAEM 2023; 4:1152-1156. [PMID: 38024589 PMCID: PMC10660090 DOI: 10.1002/jha2.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 12/01/2023]
Abstract
The coexistence of chronic myeloid leukemia (CML) and multiple myeloma (MM) is a rare clinical condition. By means of FISH and molecular analysis on both sorted CD138 plasma cells and cryopreserved CD34 stem cells, a distinct clonal origin of the hematological malignancies was demonstrated in our case. We report on the first patient diagnosed with CML and MM treated with daratumumab, bortezomib, thalidomide, and dexamethasone (Dara-VTd) induction, stem-cell collection, and autologous stem cell transplantation (ASCT). The co-administration of Dara-VTd and imatinib proved feasible and highly effective in the management of both CML and MM. Despite concerns with stem cell mobilization and collection in patients exposed to daratumumab, in our experience the use of higher cyclophosphamide dose 4 g/m2 together with plerixafor granted optimal stem cell mobilization and collection, irrespective of daratumumab, concomitant myeloid neoplasm, and imatinib. Moreover, ASCT was easily performed with a rapid hematological reconstitution.
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Affiliation(s)
- Carmine Liberatore
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Francesca Fioritoni
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Annalisa Natale
- Bone Marrow Transplant Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Guido Montanaro
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Gaetano La Barba
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Cecilia Passeri
- Blood Bank Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Ornella Iuliani
- Blood Bank Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Bianca Fabi
- Blood Bank Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Stefano Baldoni
- Blood Bank Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Donatella Fantasia
- Onco‐hematological Genetics, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Giuseppe Calabrese
- Onco‐hematological Genetics, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Patrizia Accorsi
- Bone Marrow Transplant Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Stella Santarone
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Stefano Pulini
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
| | - Mauro Di Ianni
- Hematology Unit, Department of Oncology and HematologyPescara HospitalPescaraItaly
- Department of Medicine and Sciences of AgingUniversity of Chieti‐PescaraChietiItaly
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Mangal V, Paresh S, Adwait S, Nachiketa D. Uncommon simultaneous diagnosis of multiple myeloma and chronic myeloid leukaemia. J R Coll Physicians Edinb 2021; 50:303-304. [PMID: 32936109 DOI: 10.4997/jrcpe.2020.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Chronic myeloid leukaemia (CML) is a clonal hematopoietic stem cell disorder. The annual incidence of CML is 1.5 cases per 100,000 individuals. Multiple myeloma (MM) represents a malignant proliferation of plasma cells derived from a single clone. The co-occurrence of two rare malignancies CML and MM in the same patient is an extremely rare incident, and simultaneous diagnosis of CML and MM is reported in only five cases in the literature. A 75-year-old male presented with complaints of easy fatigability, loss of appetite and unquantifed weight loss of four months' duration. On evaluation he was found to have normocytic normochromic anaemia, leucocytosis, elevated serum-calcium concentration and azotaemia. Peripheral blood for the BCR-ABL fusion gene product was positive by flourescence in situ hybridisation (FISH). However, bone marrow biopsy revealed CD138 positive, 15% plasma cells. Thus the diagnosis of CML and MM was established. Although we can't be certain regarding the cause of CML and MM in our patient, the hypothesis that they evolved from common malignant pluripotent hematopoietic stem cells still holds. However, at the age of 75 years, it might be just due to chance.
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Affiliation(s)
- Vishal Mangal
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, Maharashtra, India,
| | - Singhal Paresh
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - Sodani Adwait
- Department of Medicine, Armed Forces Medical College, Pune, India
| | - Dr Nachiketa
- Department of Pathology, Armed Forces Medical College, Pune, India
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Ouyang W, Zhao X, Lu S, Wang Z. Prevalence of monoclonal gammopathy of uncertain significance in chronic myeloid leukemia: A case report. Medicine (Baltimore) 2018; 97:e13103. [PMID: 30383696 PMCID: PMC6221681 DOI: 10.1097/md.0000000000013103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE The abnormal cell types in chronic myeloid leukemia (CML) and monoclonal gammopathy of uncertain (MGUS) are quite different, being myeloid and plasma cells, respectively. The coexistence of CML and MGUS is an uncommon event, which is seldom reported in literature. PATIENT CONCERNS A 52-year-old female was diagnosed with CML in April 2001. From November 2006, the patient started on imatinib mesylate and kept a complete hematologic and cytogenetic response for nearly 11 years. During her follow-up on July 7, 2017, thrombocytopenia (35*109/L) was found. Bone marrow aspiration revealed 6% plasma cell infiltration. Serum immunoelectrophoresis revealed 1.24 g/dL of serum monoclonal (M) protein of IgG-κ type. DIAGNOSIS MGUS was diagnosed because of absence of anemia, hypercalcemia, lytic bone lesions, or renal failure. Immune thrombocytopenia (ITP) was also diagnosed in this patient following the detection of antiplatelet autoantibodies. Complex karyotype and missense mutation in PRDM1 were identified. INTERVENTIONS Because of her obvious decrease of platelets, she started treatment with thalidomide and prednisone. OUTCOMES Three months later, bone marrow aspirate showed disappearance of plasma cells. There developed an abrupt decrease in IgG and the absence of M-spike in serum immunoelectrophoresis. The platelet count kept normal during 1 year follow-up. LESSONS Karyotypic event and gene mutation found in this case may be the initiation of disease transformation. Administration of thalidomide and prednisone proved effective in this patient.
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An Unprecedented Case of p190 BCR-ABL Chronic Myeloid Leukemia Diagnosed during Treatment for Multiple Myeloma: A Case Report and Review of the Literature. Case Rep Hematol 2018; 2018:7863943. [PMID: 30405922 PMCID: PMC6199862 DOI: 10.1155/2018/7863943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/26/2018] [Indexed: 01/17/2023] Open
Abstract
We report the case of a 76-year-old man who was diagnosed as having chronic myeloid leukemia (CML) with p190 BCR-ABL while receiving treatment for symptomatic multiple myeloma (MM). The diagnosis of MM was based on the presence of serum M-protein, abnormal plasma cells in the bone marrow, and lytic bone lesions. The patient achieved a partial response to lenalidomide and dexamethasone treatment. However, 2 years after the diagnosis of MM, the patient developed leukocytosis with granulocytosis, anemia, and thrombocytopenia. Bone marrow examination revealed Philadelphia chromosomes and chimeric p190 BCR-ABL mRNA. Fluorescence in situ hybridization also revealed BCR-ABL-positive neutrophils in the peripheral blood, which suggested the emergence of CML with p190 BCR-ABL. The codevelopment of MM and CML is very rare, and this is the first report describing p190 BCR-ABL-type CML coexisting with MM. Moreover, we have reviewed the literature regarding the coexistence of these diseases.
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Ryzhko VV, Grachev AE, Klodzinsky AA, Ivanova TV, Sataeva MS, Gribanova EO. Myeloproliferative masks of multiple myeloma: A review of literature and clinical case reports. TERAPEVT ARKH 2017; 89:72-77. [DOI: 10.17116/terarkh201789172-77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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.
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Ali N, Pickens PV, Auerbach HE. Immunoglobulin D Multiple Myeloma, Plasma Cell Leukemia and Chronic Myelogenous Leukemia in a Single Patient Treated Simultaneously with Lenalidomide, Bortezomib, Dexamethasone and Imatinib. Hematol Rep 2016; 8:6295. [PMID: 27103978 PMCID: PMC4815947 DOI: 10.4081/hr.2016.6295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/19/2016] [Accepted: 01/19/2016] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma (MM) is a neoplastic lymphoproliferative disorder characterized by uncontrolled monoclonal plasma cell proliferation. Among different isotypes of MM, immunoglobulin D (IgD) MM is very rare, representing only 1 to 2% of all isotypes. Chronic myelogenous leukemia (CML) is a neoplastic myeloproliferative disorder of pluripotent hematopoietic stem cell, which is characterized by the uncontrolled proliferation of myeloid cells. An 88-year-old male was diagnosed simultaneously with IgD kappa MM and CML. A distinctive feature in this patient was the progression to plasma cell leukemia without any symptomatic myeloma stage. He was treated simultaneously with lenalidomide, bortezomib and imatinib. Synchronous occurrence of these rare hematological malignancies in a single patient is an exceedingly rare event. Multiple hypotheses to explain co-occurrence of CML and MM have been proposed; however, the exact etiological molecular pathophysiology remains elusive.
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Affiliation(s)
- Naveed Ali
- Departments of Internal Medicine, Abington Memorial Hospital/Abington-Jefferson Health , PA, USA
| | - Peter V Pickens
- Departments of Hematology and Oncology, Abington Memorial Hospital/Abington-Jefferson Health , PA, USA
| | - Herbert E Auerbach
- Departments of Pathology, Abington Memorial Hospital/Abington-Jefferson Health , PA, USA
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A case of multiple myeloma with metachronous chronic myeloid leukemia treated successfully with bortezomib, dexamethasone, and dasatinib. Case Rep Oncol Med 2014; 2014:962526. [PMID: 25544920 PMCID: PMC4269179 DOI: 10.1155/2014/962526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/15/2014] [Indexed: 11/30/2022] Open
Abstract
The coexistence of multiple myeloma and chronic myeloid leukemia in a single patient is a very rare event that has been reported very infrequently in the literature. We report a case of a patient who developed chronic myeloid leukemia four years after his diagnosis with multiple myeloma. Historically, no link between the two malignancies has been identified. This synchronous existence complicates the treatment plan for these patients, and there is a lack of evidence on the best therapeutic approach. Our patient was successfully treated with a combination of bortezomib, dexamethasone, and dasatinib, which he tolerated well for eleven months until he eventually succumbed to cardiac complications and pulmonary hypertension leading to his death.
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8
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Unusual case of simultaneous presentation of plasma cell myeloma, chronic myelogenous leukemia, and a jak2 positive myeloproliferative disorder. Case Rep Hematol 2014; 2014:738428. [PMID: 25386371 PMCID: PMC4214051 DOI: 10.1155/2014/738428] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Multiple articles discuss the rare incidence and potential causes of second hematologic disorders arising after treatment of Chronic Myelogenous Leukemia (CML), leading to the theory of imatinib, the current treatment regimen for CML, as a possible trigger for the development of secondary neoplasms. Our case eliminates the possibility of imatinib as the sole cause since our patient received a diagnosis of simultaneous plasma cell myeloma, CML, and a Jak2 mutation positive myeloproliferative disorder (MPD) arising de novo, prior to any treatment. We will further investigate into alternative theories as potential causes for multiple hematopathologic disorders. Case Report. There are currently no reported cases with the diagnosis of simultaneous plasma cell myeloma, chronic myelogenous leukemia, and Jak2 positive myeloproliferative disorder. We present a case of a 77-year-old male who was discovered to have these three concurring hematopathologic diagnoses. Our review of the literature includes a look at potential associations linking the three coexisting hematologic entities. Conclusion. The mechanism resulting in simultaneous malignancies is most likely multifactorial and potentially includes factors specific to the host, continuous stimulation of the immune system, previous chemotherapy or radiation, a potential common pluripotent stem cell, or, lastly, preexisting myeloma which may increase the susceptibility of additional malignancies.
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Guru Murthy GS, Sawyer J, Alapat D, Samant R, Barlogie B. Strange bedfellows: mitotically active chronic myeloid leukemia in molecular complete remission, detected in focal lesion of myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e127-9. [PMID: 24685577 DOI: 10.1016/j.clml.2014.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/14/2014] [Indexed: 11/18/2022]
MESH Headings
- Aged
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Karyotype
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Magnetic Resonance Imaging
- Male
- Multiple Myeloma/diagnosis
- Multiple Myeloma/drug therapy
- Multiple Myeloma/etiology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Remission Induction
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
| | - Jeffrey Sawyer
- Division of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Daisy Alapat
- Division of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Rohan Samant
- Division of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Bart Barlogie
- Myeloma Institute of Research and Therapy, Little Rock, AR.
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10
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Ragupathi L, Najfeld V, Chari A, Petersen B, Jagannath S, Mascarenhas J. A Case Report of Chronic Myelogenous Leukemia in a Patient With Multiple Myeloma and a Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:175-9. [DOI: 10.1016/j.clml.2012.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/03/2012] [Accepted: 09/17/2012] [Indexed: 11/15/2022]
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11
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Offiah C, Quinn JP, Thornton P, Murphy PT. Co-existing chronic myeloid leukaemia and multiple myeloma: rapid response to lenalidomide during imatinib treatment. Int J Hematol 2012; 95:451-2. [PMID: 22426625 DOI: 10.1007/s12185-012-1038-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 02/20/2012] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
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12
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Coexistence of chronic myeloid leukemia and pulmonary plasmacytoma mimicking primary lung cancer. Int J Hematol 2010; 92:651-4. [PMID: 20967517 DOI: 10.1007/s12185-010-0705-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/17/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
Abstract
A 61-year-old man was diagnosed with the simultaneous occurrence of chronic myeloid leukemia (CML) and infiltrative intrathoracic plasmacytoma, radiologically mimicking bronchogenic carcinoma. Following the administration of imatinib mesylate (IM; 400 mg/day), both hematologic and partial cytogenetic remission of CML were achieved. However, the pulmonary plasmacytoma was persistently aggravated. High-dose dexamethasone was added to the IM therapy because the patient refused radiotherapy to control the aggravated pulmonary plasmacytoma. Finally, he died due to pneumonia and multi-organ failure during concurrent administration of IM and high-dose dexamethasone.
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13
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Ide M, Kuwahara N, Matsuishi E, Kimura S, Gondo H. Uncommon case of chronic myeloid leukemia with multiple myeloma. Int J Hematol 2010; 91:699-704. [PMID: 20352382 DOI: 10.1007/s12185-010-0546-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 02/17/2010] [Accepted: 02/21/2010] [Indexed: 01/22/2023]
Abstract
We describe a 72-year-old woman who was diagnosed with asymptomatic multiple myeloma (MM) while being treated for Philadelphia (Ph)-positive chronic myeloid leukemia (CML) with imatinib mesylate (400 mg/day). The diagnosis of CML was based on the presence of the Ph chromosome and chimeric BCR-ABL messenger RNA. Three months after starting imatinib mesylate treatment, the patient achieved a complete cytogenetic response. However, bone marrow analysis at that time demonstrated plasmacytosis, and paraprotein (IgG, kappa-type) was also detected. Hypercalcemia, renal failure, anemia, and bone lesions were not observed, which suggested that asymptomatic MM had developed. The coexistence of CML and MM is an extremely uncommon event that has only been reported in 12 cases. We discuss the relationship between CML and MM.
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Affiliation(s)
- Masaru Ide
- Department of Hematology, Saga Prefectural Hospital Koseikan, Saga, Japan.
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14
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Michael M, Antoniades M, Lemesiou E, Papaminas N, Melanthiou F. Development of Multiple Myeloma in a Patient with Chronic Myeloid Leukemia While on Treatment with Imatinib Mesylate for 65 Months. Oncologist 2009; 14:1198-200. [PMID: 19955186 DOI: 10.1634/theoncologist.2009-0165] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The simultaneous occurrence of multiple myeloma (MM) and chronic myeloid leukemia (CML) is an extremely rare event that has been reported in only eight cases in the literature. We report here on only the third case of the development of MM in a patient with CML on treatment with imatinib mesylate, and to our knowledge, this is the first case in a patient who received imatinib as first-line treatment.
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Affiliation(s)
- Michalis Michael
- Department of Haematology, Nicosia, General Hospital, 2 Amfipoleos Street, 2025, Nicosia, Cyprus.
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15
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Incidental diagnosis of CML in a patient with anemia and IgG lamda monoclonal protein in blood. Ann Hematol 2009; 88:1041. [DOI: 10.1007/s00277-009-0725-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 02/26/2009] [Indexed: 10/21/2022]
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16
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Laibe S, Tadrist Z, Arnoulet C, Sainty D, Mozziconacci MJ. A myeloproliferative disorder may hide another one. Leuk Res 2009; 33:1133-6. [PMID: 19250672 DOI: 10.1016/j.leukres.2009.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/28/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
Abstract
Chronic myeloproliferative disorders (MPDs) are divided into Philadelphia-positive chronic myeloid leukemia (CML) and Philadelphia-negative disorders including polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis (IMF). Concomitance of a CML and another MPD is a rare event. We report here the case of a patient presenting initially with IMF who developed a Philadelphia-positive CML 7 years later. At the time of CML diagnosis, two distinct clones were present, one with a 13q deletion and one with a t(9;22). We raise the problem of a CML developing on an initial IMF, or two MPDs occurring from a common or two different stem cells.
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Affiliation(s)
- Sophy Laibe
- Département de Biopathologie, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille Marseille, France
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Galanopoulos A, Papadhimitriou SI, Kritikou-Griva E, Georgiakaki M, Anagnostopoulos NI. Μultiple myeloma developing after imatinib mesylate therapy for chronic myeloid leukemia. Ann Hematol 2008; 88:281-2. [DOI: 10.1007/s00277-008-0597-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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