Coexistence of Primary Myelodysplastic Syndrome and Multiple Myeloma

Coexistence of multiple myeloma (MM) and myelodysplastic syndrome (MDS) are rare. It has been known that coexistence of MM and MDS may occur as a complication of treatment. Due to treatment with alkylating agents myelodysplastic syndrome (MDS) may occur in multiple myeloma patients. Here we report a case of coexistent MM and MDS in a patient without history of treatment with any cytotoxic drugs or radiation therapy.
A 63-years-old female was presented to our clinic with fever and weakness. Her blood counts were- WBC: 1.51x 109/l – HGB: 8g/dL– MCV 85.4 fl. - PLT: 71,000/mm3. Her serum total protein elevated at 10.2 g/dl albumin 4 g/dl. The peripheral blood smear showed macrocytic and normochromic cells, anisopoikilocytosis and target cells. Bone marrow biopsy specimen showed 70 % monoclonal growth of lambda-positive plasma cells infiltration and was tri-lineage cellular dysplastic features, which included multinucleated erythroblasts and dysplastic megakaryocytes with hypolobulated nucleus. 14 % myeloblasts were seen. Serum immunofixation studies showed a monoclonal IgG lambda. These findings were characteristic for Primary MDS RAEB II and MM. We started treatment for her multiple myeloma with VCD (bortezomib, cyclophosphamide and dexamethasone). Presence the coexistence of both diseases originating from different cell lines may not be rare as they known. There have been some reports of coexistence of MDS and myeloma; supporting the idea of pluripotent stem cell origin of the disease. We suggest that MM patients administrating with cytopenie should be evaluated for coexistent myeloid neoplasms.

Primer Myelodisplastik Sendrom ve Multipl Myelom Birlikteliði

Multipl miyelom (MM) ve myelodisplasik sendrom (MDS) birlikteliðine nadir rastlanmaktadýr. MM tedavisinde kullanýlan alkilleyici ajanlarýn bir komplikasyonu olarak MDS geliþimi olabileceði bilinmektedir. Bu yazýmýzda öncesinde herhangi bir alkilleyici ajan tedavisi ve radyoterapi maruziyeti olmaksýzýn eþzamanlý MDS ve MM geliþen bir olgumuzu tartýþtýk. 63 yaþýnda kadýn hasta, ateþ ve halsizlik þikâyeti ile kliniðimize baþvurdu. Laboratuvar incelemelerinde lökosit: 1.51x 109 / L, hemoglobin: 8 g/l, MCV 85.4 fl., trombosit: 71,000/mm3,total protein: 10.2 g/dl (normal deðerler: 6-8,5), albumin: 4 g/dl (normal deðerler: 3,5-5)saptandý. Periferik yaymada makrositer- normokrom eritrositler, anizopoikilositoz ve target hücreler izlendi. Hastanýn yapýlan serum immünfiksasyonunda IG G Lambda monoklonal protein saptandý. Kemik iliði aspirasyon ve biyopsisinde;% 70 atipik plazma hücre infiltrasyonu ve immünhistokimyasal incelemede bu plazma hücrelerinde IG G ve lambda ile pozitif boyanma saptandý.Kemik iliði aspirasyonunda her üç seriye ait öncül hücrelerde displastik deðiþiklikler ve 14% miyeloblast izlendi. Bu bulgularla hastamýza MM IG G Lambda ve MDS RAEB II tanýsý koyduk. Hastaya VCD (Bortezomib, Siklofosfamid ve Deksametazon) kemoterapisi baþlandý.
MDS ve MM gibi farklý hücrelerden köken aldýðý bilinen hastalýklarýn birlikteliði literatürde de görüldüðü üzere nadir deðildir ve pluripotent kök hücre kökenli olduðu fikrini desteklemektedir. Bu olguyu paylaþmamýzýn nedeni hem literatürün bu görüþünü desteklemek hem de yeni taný multipl myelom hastalarýnda görülen sitopenilerde eþlik edebilecek diðer myeloid neoplazilerinde akla getirilmesine dikkat çekmektir.