Department of Hematology-Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
J Med Case Rep. 2023 Feb 5;17(1):35. doi: 10.1186/s13256-023-03753-z.
Synchronous or metachronous multiple primary malignancies (MPMs) are a known phenomenon. These occurrences may be spontaneous or related to environmental risk factors or genetic predisposition. Chronic myelogenous leukemia (CML) and Multiple myeloma (MM) are two uncommon hematologic malignancies, arises from two different cell lineage. The coexistence of CML and MM that is a rare phenomenon, with only 29 cases reported in the literature. To the best of our, this combination of triple primary cancers has not been reported in a single patient.
Herein, we reported a case of an 85-year-old Iranian male with three confirmed primary malignant neoplasms. The patient presented with synchronous prostate cancer and CML, in august 2016. He received imatinib and nilotinib for CML and hormonal therapy for prostate cancer. He remained in good control at further follow-ups for about 5 years. In the follow-up period and after 61 months treatment with tyrosine kinase inhibitors (TKIs), CML was undetectable in molecular tests, but the presence of serum M-protein, abnormal plasma cells in the bone marrow, and CRAB criteria was compatible with MM.
We must evaluate the possibility of multiple primary cancers during cancer treatment and follow-up and it may be worthwhile to monitor serum electrophoresis and protein levels in TKIs-treated patients.
同步或异时性多原发恶性肿瘤（MPMs）是已知的现象。这些发生可能是自发的，也可能与环境危险因素或遗传易感性有关。慢性髓细胞白血病（CML）和多发性骨髓瘤（MM）是两种罕见的血液系统恶性肿瘤，来源于两个不同的细胞谱系。CML 和 MM 同时存在是一种罕见的现象，文献中仅报道了 29 例。据我们所知，这种三联原发性癌症的组合在单个患者中尚未报道过。
在此，我们报告了一例 85 岁的伊朗男性，他患有三种明确的原发性恶性肿瘤。该患者于 2016 年 8 月出现同步前列腺癌和 CML。他接受了伊马替尼和尼罗替尼治疗 CML 和激素治疗前列腺癌。在进一步随访的大约 5 年中，他的病情控制良好。在随访期间，在接受酪氨酸激酶抑制剂（TKIs）治疗 61 个月后，分子检测未检测到 CML，但血清 M 蛋白、骨髓中异常浆细胞和 CRAB 标准与 MM 相符。
我们必须在癌症治疗和随访期间评估发生多种原发性癌症的可能性，对于接受 TKI 治疗的患者，监测血清电泳和蛋白水平可能是值得的。
