Therapy-related acute lymphoblastic leukemia following treatment for multiple myeloma – diagnostic and therapeutic dilemma

Figures & data

Figure 1. Cytograms from the diagnosis of ALL.

Table 1. The characteristics of the study group, cytogenetic changes, and treatment protocols.

Patient	Age at MM/ALL	Sex	Melphalan	Years from MM diagnosis	Len Maintenance (years)	ALL cytogenetics/ FISH	MM Status	ALL therapy	Allo-HCT	Outcome	Follow-up from ALL (months)
1^9	62/64	F	Yes AHCT	2	1.6	46,XX	VGPR	Induction therapy for adult ALL	No	Deceased (infection)	No data
2^10	59/62	M	Yes AHCT	3	2.5	46,XY,del20q	CR	UCSF protocol 8707	Yes	CR for both MM and ALL	+12 months
3^10	34/40	M	No	6	3	Abnormality of chromosome 14	CR	CALGB	No	Deceased	1 month
4^10	53/61	M	Yes AHCT	8	7	Small population of tetraploid cells	No data	UCSF protocol 8707; II AHCT	No (no donor)	CR for both MM and ALL	+12 months
5^11	67/70	F	Yes AHCT	3.75	3	46,XX/46,XX,t(7;19)	VGPR	Hyper-CVAD, POMP maintenance	No	CR- ALL, VGPR - MM	+36 months
6^11	53/60	F	Yes AHCT	7.5	6	48,XX,+8,+10,+21,-20 FISH MYC, IgH gene locus copy gain	CR	CALGB 8811, POMP maintenance	No	CR for both MM and ALL	+12 months
7^12	65/68	F	Yes	3.2	1.2/next 2 years of thal	No karyotype	CR	No treatment	No	Deceased (respiratory failure)	4 months
8^13	72/80	M	No	8	3	No data	CR	Hyper-CVAD/MA POMP maintenance	No	CR 2010-2012, relapse, clinical trial	+24 months
9^14	64/68	M	Yes AHCT	3.8	1.8	FISH: del 13q, 17p, 4p, 16q, 4;	CR	Hyper-CVAD/MA, POMP maintenance	No	CR for both MM and ALL	16 months
10^14	43/50	M	Yes AHCT	7.4	6.3	Relapse: low-level copy number gains in chromosomes 1, 6, 8, 10, 11q, 14q, 18, 19, 21q, and 22q. Mutation TP53, CREBBP	CR	Hyper-CVAD/MA POMP maintenance, inotuzumab ozogamicin	No	CR next relapse Deceased	22 months
11^15	67/82	M	Yes- MP	15	8	48,XY,+8,+21/ near tetraploid FISH : del TP53,	VGPR	DVd, inotuzumab ozogamicin	No	PR	+15 months
12^16	Nd	M	Yes AHCT	6	>5	46,XY t(12;21)	CR	Hyper-CVAD	Yes	Relapse 1 year after allo-HCT; next inotuzumab CR2	+12 months
13^17	73/78	F	No	4.6	4.6	46,XX FISH: copy gain MYC, IGH, 5p/5q; del TP53, del ABL, −7, del20q, +8,	CR	DNR,VCR,Pred Cx,AraC,6MP HD-MTX Relapse: VCR,Dx	no	CR next relapse Deceased discontinuation of treatment	nd
14^18	nd/65	F	Yes AHCT	nd	5	47,XX,+8; TP53 mutation	CR	No data	No data	No data	No data
15 Our case	55/59	M	Yes AHCT	3.6	3	Hypodiploid	CR	PALG >55yo	Yes	CR for both MM and ALL	+18 months

CALBG: cyclophosphamide, daunorubicin, vincristine, prednisone, and l-asparaginase; Hyper-CVAD: cyclophosphamide, vincristine, adriamycin, dexamethasone; POMP: mercaptopurine, vincristine, methotrexate, prednisone; MP: melphalan, prednisone; DVd: liposomal doxorubicin, vincristine, dexamethasone; 6-MP: mercaptopurine; DNR: daunorubicin; VCR: vincristine; CR: complete response; VGPR: very good partial response; PR: partial response; AHCT: autologous hematopoietic cell transplantation.

Data availability statement

The data that support the findings of this study are openly available https://pubmed.ncbi.nlm.nih.gov/. Reference number: DOI:10.3109/10428194.2013.786072, DOI:10.1002/hon.2248, DOI:10.1155/2018/9052314, DOI:10.5301/tj.5000377, PMID: 23694793, DOI:10.1093/AJCP/AQAA109, DOI:10.1186/s12885-019-6286-9, PMID: 24966987, DOI:10.7759/cureus.6009, DOI:10.1182/blood.2020009141.