Title:From Multiple Myeloma to Acute Myeloid Leukemia: A Case Report of a
61-year-old Woman after 8 Years of Chemotherapy and Immunotherapy
Volume: 19
Issue: 3
Author(s): Xue-Hang Fu, Rong-Yan Guan, Zoufang Huang, Yun Li, Guang Lu, Wei-Wei Mou*Jun Du*
Affiliation:
- Department
of Pediatrics, Shengli Oilfield Central Hospital, Dongying, 257034, China
- Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
Keywords:
Myeloma, acute myeloid, leukemia, clone evolution, chemotherapy, immunotherapy.
Abstract:
Background: As the second most prevalent hematologic malignancy, multiple myeloma
(MM) affects plasma cells and is characterized by chromosomal abnormalities, particularly
involving the immunoglobulin heavy chain switch region. MM represents a biologically and clinically
heterogeneous hematological malignancy that serves as a clonal evolution model, exhibiting
clonal heterogeneity throughout all stages from monoclonal gammopathy undetermined significance
(MGUS) and smoldering multiple myeloma (SMM) to MM. Although significant progress
has been made in the treatment of MM, leading to improved patient outcomes, concerns are arising
regarding disease relapse due to the presence and selection of pre-existing resistant clones or
selective pressure during therapy.
Case Presentation: We present a case of multiple myeloma (MM) in a female patient, who underwent
an 8-year course of treatment, including chemotherapy, immunomodulators, hematopoietic
stem cell transplantation, CD38 monoclonal antibody, and chimeric antigen receptor T-cell
(CAR-T), and was recently diagnosed with concurrent progressive MM and acute myeloid leukemia
(AML). This patient has witnessed the evolution of MM treatment paradigms.
Conclusion: In this course, disease relapses occurred twice, one of which was manifested by a
light chain escape (LCE). Moreover, through the course of the disease in this patient, we review
the process of clonal evolution that may be relevant.
