Open AccessAcute lymphoblastic leukemia as a clonally unrelated second primary malignancy after multiple myeloma
Author(s) -
Ibrahim Aldoss,
Marzia Capelletti,
Jihye Park,
Romanos Sklavenitis Pistofidis,
Raju Pillai,
Tracey Stiller,
James F. Sanchez,
Stephen J. Forman,
Irène M. Ghobrial,
Amrita Krishnan
Publication year - 2018
Publication title -
leukemia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.539
H-Index - 192
eISSN - 1476-5551
pISSN - 0887-6924
DOI - 10.1038/s41375-018-0213-y
Subject(s) - multiple myeloma , clone (java method) , malignancy , medicine , oncology , leukemia , monosomy , transplantation , hematopoietic stem cell transplantation , karyotype , myeloid leukemia , population , acute lymphocytic leukemia , immunology , biology , lymphoblastic leukemia , genetics , chromosome , dna , environmental health , gene
Multiple myeloma (MM) patients have an 11-fold increased risk of developing myeloid neoplasms compared to the general population; however, acute lymphoblastic leukemia (ALL) is rarely observed. Given that both MM and the majority of ALL are of B cell origin, this raises the question of whether ALL in patients with MM arises from the same clone. We report 13 cases of B-cell ALL following therapy for MM. The interval from MM diagnosis to ALL onset was 5.4 years (range 3.3-10). The median age at the time of ALL diagnosis was 60 years (range 43-67). MM therapy included immunomodulatory agents in all patients and autologous hematopoietic cell transplantation in 10 (77%) patients preceding ALL diagnosis. ALL genetics showed a normal karyotype, TP53 mutation/deletion, and monosomy 7 or 7q deletion in 5, 3, and 2 cases, respectively. Analysis of paired samples of MM and ALL using whole exome sequencing demonstrated that the malignancies arose from different clones. Thus, ALL as a second primary malignancy following MM is not clonally related but could potentially represent a therapy-related leukemia.