Abstract

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.