Acute lymphoblastic leukemia secondary to multiple myeloma
Acute lymphoblastic leukemia (ALL) secondary to multiple myeloma (MM) is rare. Published in the journal Medicine, the authors report a rare case of secondary ALL transformed from MM.

A 64-year-old woman was diagnosed as MM IgG light chain type in the past. She achieved complete remission after 2 cycles of therapy, and received maintenance therapy with thalidomide. The patient suffered from MM relapse. Bone marrow examination showed that the percentage of primary lymphocytes was 59%, indicating ALL-L2 (Pre-B-ALL). The patient reached complete remission after 1 cycle of chemotherapy, and has been maintained for more than 6 years.

Immunophenotyping analysis revealed that the abnormal cell population accounted for approximately 66% which expressed HLA-DR, CD4, CD22, CD33, CD34, and cCD79a. These results indicated acute B lymphoblastic leukemia. Chromosome presented 47, XX, +5, −7, +19. Leukemia fusion gene analysis demonstrated positive EVI1 and negative IgH and TCR gene rearrangement.

The patient accepted 1 cycle of VDCLP chemotherapy and reached complete remission, followed with consolidation therapies with VDCLP, MA, CAG and other chemotherapy regimens. This patient has maintained CR1 of ALL for more than 6 years.

Key takeaway:-
The present case suggests that one should pay attention to MM secondary to ALL and take proper measure of treatment.

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