Rapid Evolution of a Myelodysplastic Syndrome in a Case of Multiple-Myeloma: Therapy Related or Not?

Case Report

Ann Hematol Oncol. 2017; 4(4): 1147.

Rapid Evolution of a Myelodysplastic Syndrome in a Case of Multiple-Myeloma: Therapy Related or Not?

Debord C¹, Touzeau C², Theisen O¹, Béné MC¹ and Eveillard M¹*

¹Department of Hematology Biology, Nantes University Hospital, France

²Department of Hematology, Nantes University Hospital, France

*Corresponding author: Marion Eveillard, Department of Hematology Biology, Nantes University Hospital, Nantes, France

Received: March 13, 2017; Accepted: April 06, 2017; Published: April 25, 2017

Abstract

An unusual case of concomitant lymphoid and myeloid neoplasias is presented, where a woman with a history of multiple myeloma developed pancytopenia and dysgranulopoiesis in the peripheral blood. Bone marrow examination confirmed an additional diagnosis of myelodysplastic syndrome with excess blasts. This MDS could be either linked to MM treatment or to the increased risk of MM patients to develop secondary myelodysplasia. Interestingly, MDS-specific del(5q) and a t(2;12) were observed on the myeloid karyotype. This case highlights that bone marrow examination is mandatory when cytopenias are disclosed on blood cell counts.

Keywords: Multiple myeloma, Myelodysplasia; Bone marrow

Case Presentation

A 66-year-old woman was diagnosed with an IgA-kappa multiple myeloma (MM) without del(17p) or t(4;14) as assessed by Fluorescence In Situ Hybridization. She had received a first line of therapy associating bortezomib, thalidomide and dexamethasone followed by autologous stem-cell transplantation (auto-SCT). She relapsed one year later and received a regimen of lenalidomide and dexamethasone. She developed two thromboembolic episodes and was then enrolled in a clinical trial comprising carfilzomib. After the second cycle, three years after the initial diagnosis and two years after auto-SCT, she had a routine check of peripheral blood (PB) parameters. This complete blood count disclosed pancytopenia with normocytic anemia (10.4 g/dL, 87 fL), thrombopenia (108x109/L) and neutropenia (1.43x109/L). The PB smear showed 3% blasts (Figure 1A) and major dysgranulopoiesis (Figure 1B, 1C). These abnormal features, possibly heralding impending relapse, prompted to perform a bone marrow (BM) aspiration. BM smears were rich with 4.5% of abnormal plasma-cells (Figure 1D, 1E), 2% blasts and major erythroblastosis (62.5%). Morphological examination also disclosed multilineage dysplasia with monolobated megakaryocytes (Figure 1D) and dysgranulopoiesis characterized by cytoplasmic hypogranularity and nuclear hypolobation (Figure 1E, 1F). Dyserythropoiesis was also observed, with the presence of bilobated nuclei (Figure 1G). Conventional cytogenetics was performed on BM and detected a del(5q) and a t(2;12)(q12;q13). This led, in addition to the partially controlled MM, to a diagnosis of myelodysplastic syndrome with excess blasts type 1 (MDS-EB1) according to the 2016 WHO classification [1].

Citation:Debord C, Touzeau C, Theisen O, Béné MC and Eveillard M. Rapid Evolution of a Myelodysplastic Syndrome in a Case of Multiple-Myeloma: Therapy Related or Not?. Ann Hematol Oncol. 2017; 4(4): 1147. ISSN:2375-7965