Simultaneous Presentation of Waldenström Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

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概要

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• Waldenström macroglobulinemia and multiple myeloma are mature B-cell neoplasms deriving from post-germinal cells at different stages of differentiation. The simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma in the same patient is a very rare phenomenon and, so far, only two cases have been described. We report the case of a 75-year Caucasian female patient, with a silent clinical history, who presented with anemia and two different monoclonal proteins (IgMκ and IgGκ). The trephine biopsy showed the presence of a dual population, represented by small lymphoplasmacytoid cells and by plasma cells, which infiltrated the bone marrow with a clearly different pattern. Both immunohistochemistry and flow cytometry demonstrated the biclonal origin such neoplastic cells, since lymphoplasmacytoid cells resulted IgMκ while plasma cells were IgGκ. This biclonal pattern was further confirmed by the demonstration of a different <I>IgH</I> gene rearrangement of the two neoplasms. The patient was treated with bortezomib, dexamethasone and rituximab, achieving partial remission of both Waldenström macroglobulinemia and multiple myeloma. After a 30-month follow-up, she is in stable disease. Multiple myeloma has been described in association with other indolent B-cell neoplasms, mostly chronic lymphocytic leukemia, while Waldenström macroglobulinemia can be followed by diffuse large B-cell lymphoma in some instances, after chemotherapy. The association of Waldenström macroglobulinemia and multiple myeloma seems to be very rare. Our study shows that an integrated diagnostic work-up is very useful in such cases, with an interesting role for flow cytometry. [<I>J Clin Exp Hematop 53(</I><I>1): 29-36,</I> <I>2013</I>]

著者

• Grassi Susanna

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Marini Alessandra

  Laboratory of Clinical Pathology, Versilia Hospital, Lido di Camaiore

• Carulli Giovanni

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Ciancia Eugenio

  Second Division of Pathology AOUP, Pisa

• Azzarà Antonio

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Ottaviano Virginia

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Ciabatti Elena

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Ferreri Maria

  Laboratory of Cytogenetics AOUP, Pisa

• Rocco Melania

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

• Petrini Mario

  Division of Hematology, Department of Clinical and Experimental Medicine, University of Pisa

関連論文

• Simultaneous Presentation of Waldenström Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

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