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Leukemia. 2019 Jan;33(1):266-270. doi: 10.1038/s41375-018-0213-y. Epub 2018 Jul 19.

Acute lymphoblastic leukemia as a clonally unrelated second primary malignancy after multiple myeloma.

Author information

1
Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, CA, USA.
2
Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA.
3
Department of Pathology, City of Hope, Duarte, CA, USA.
4
Department of Information Science, City of Hope, Duarte, CA, USA.
5
The Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA.
6
Division of Hematological Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA. Irene_Ghobrial@DFCI.harvard.edu.
7
The Judy and Bernard Briskin Center for Multiple Myeloma Research, City of Hope, Duarte, CA, USA. akrishnan@coh.org.

Abstract

Multiple myeloma (MM) patients have an 11-fold increased risk of developing myeloid neoplasms compared to the general population; however, acute lymphoblastic leukemia (ALL) is rarely observed. Given that both MM and the majority of ALL are of B cell origin, this raises the question of whether ALL in patients with MM arises from the same clone. We report 13 cases of B-cell ALL following therapy for MM. The interval from MM diagnosis to ALL onset was 5.4 years (range 3.3-10). The median age at the time of ALL diagnosis was 60 years (range 43-67). MM therapy included immunomodulatory agents in all patients and autologous hematopoietic cell transplantation in 10 (77%) patients preceding ALL diagnosis. ALL genetics showed a normal karyotype, TP53 mutation/deletion, and monosomy 7 or 7q deletion in 5, 3, and 2 cases, respectively. Analysis of paired samples of MM and ALL using whole exome sequencing demonstrated that the malignancies arose from different clones. Thus, ALL as a second primary malignancy following MM is not clonally related but could potentially represent a therapy-related leukemia.

PMID:
30026571
DOI:
10.1038/s41375-018-0213-y
[Indexed for MEDLINE]

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