Hematology and Oncology, VA West Los Angeles Medical Center, Los Angeles, California, USA
Hematology and Oncology, University of California Los Angeles, Los Angeles, California, USA.
BMJ Case Rep. 2022 Jun 22;15(6):e249637. doi: 10.1136/bcr-2022-249637.
Although patients with multiple myeloma (MM) have improved survival with current therapies, there remains a long-term risk of treatment-associated second primary malignancies. We present a case of a patient with IgG kappa MM undergoing treatment for relapsed disease who was noted to have progressive pancytopenia. For his MM, he had previously undergone autologous stem cell transplant with high-dose melphalan and had received immunomodulatory (IMiD) agents in induction, maintenance and relapse regimens. A peripheral blood smear showed abnormal lymphoid cells, and a bone marrow biopsy revealed B-cell acute lymphoblastic leukaemia (B-ALL). He underwent intensive induction chemotherapy with plans for possible allogeneic stem cell transplant. Secondary B-ALL is a rare occurrence in patients with MM, with exposure to alkylating and IMiD agents being potential risk factors.
虽然多发性骨髓瘤 (MM) 患者的当前治疗方法已经提高了生存率，但仍存在长期治疗相关继发原发性恶性肿瘤的风险。我们报告了一例 IgG kappa MM 患者，该患者在接受复发性疾病治疗时出现进行性全血细胞减少。他之前接受过高剂量马法兰的自体干细胞移植，并在诱导、维持和复发方案中接受了免疫调节（IMiD）药物治疗。外周血涂片显示异常淋巴细胞，骨髓活检显示 B 细胞急性淋巴细胞白血病（B-ALL）。他接受了强化诱导化疗，计划进行可能的异基因干细胞移植。MM 患者中继发 B-ALL 较为罕见，接触烷化剂和 IMiD 药物可能是潜在的危险因素。
