ObjectiveTo investigate the clinical characteristics and treatment of patients of chronic myeloid leukemia (CML) comorbid with multiple myeloma (MM).
MethodsOn September 23, 2019, a 70 years old female patient with CML comorbid with MM who was admitted to the Department of Hematology, Nanjing Medical University Affiliated Wuxi Second Hospital was selected as the study subject. She was diagnosed with CML 18 years ago. Then she was treated with imatinib mesylate for 13 years and achieved complete molecular remission (CMR). Retrospective analysis was made on the clinical data of the patient, and the clinical characteristics and therapy effect were summarized. The procedures followed in this study were in accordance with the requirements of theWorld Medical Association Declaration of Helsinkirevised in 2013.
Results① Relevant examination results of this patient were as follows. After the patient was admitted, results of relevant laboratory examination, detection of platelet antibody, bone marrow aspiration, bone marrow immunotyping, next generation sequencing, M protein level, serum immunofixation electrophoresis, urine immunofixation electrophoresis showed that hemoglobin (Hb) value was 59 g/L, and platelet count was 71×109/L; serum immunoglobulin (Ig) G, IgA and IgM level were 45.46, 0.35, 0.44 g/L, respectively; platelet glucoprotein Ⅰb was positive; plasma cell infiltration was 30.5%; monoclonal plasma cells constituted 19.1%; PRDM1 gene mutation was identified (mutation frequency was 53.7%); M protein level was 46.8 g/L; monoclonal IgGκ bands were present in the γ region; monoclonal κ light chain bands were present in the γ region. On September 26, 2019, whole-body bone imaging combination examination showed increased bone metabolism of the left sixth rib and L3 vertebrae. The patient met the diagnostic criteria for symptomatic MM (IgGκ type). She was diagnosed as CML comorbid with MM. ② On September 26, 2019, the patient started to receive bortezomib+ lenalidomide+ dexamethasone (VRD) regimen for MM, and continued to receive imatinib mesylate for CML. However, during the treatment, the patient presented with pulmonary infection, diarrhea, gastrointestinal bleeding, rash and other adverse reactions. Moreover, platelet count significantly decreased. So imatinib mesylate and lenalidomide were stopped, bortezomib and dexamethasone were delayed. At the same time, the patient received symptomatic supportive treatment. Related symptoms of the patient were improved. On October 4, 2019, treatment regimen of the patient was adjusted to VD (bortezomib + dexamethasone) regimen for MM, and imatinib mesylate was continued to treat CML, with no obvious adverse reactions. On December 3, 2019, routine blood test results showed that Hb value was 107 g/L and platelet count was 195×109/L. IgG, IgA and IgM level were 2.83, 0.02 and 0.37 g/L, respectively. M protein test results were negative. Serum and urine immunofixation electrophoresis results showed no abnormalities. No plasma cells were found on bone marrow cell morphological examination. Bone marrow immunotyping result showed 0.07% of monoclonal plasma cells. The efficacy of MM in this case was assessed as complete remission (CR). According to the quantitative results of BCR/ABL (P210) fusion gene, the efficacy of CML was evaluated as CMR. Subsequently, VD chemotherapy and imatinib mesylate were continued. As of March 2020, efficacy of MM was still CR and CML was still CMR.
ConclusionsCML comorbid with MM is rare. Patients receive VRD, VD regimen and imatinib mesylate show good efficacy, but it is noteworthy that imatinib mesylate may increase bortezomib exposure and precipitate severe adverse events. However, this study is just a retrospective study on one case, so clinical analysis and treatment results of the patient in this study need to be further verified by large sample and prospective studies.
