Therapy-related B-lymphoblastic leukemia after multiple myeloma

Michael E Kallen; Rima Koka; Zeba N Singh; Yi Ning; Mehmet H Kocoglu; Ashraf Z Badros; Sandrine Niyongere; Vu H Duong; Ashkan Emadi; Maria R Baer

doi:10.1016/j.lrr.2022.100358

Therapy-related B-lymphoblastic leukemia after multiple myeloma

Leuk Res Rep. 2022 Nov 1:18:100358. doi: 10.1016/j.lrr.2022.100358. eCollection 2022.

Authors

Michael E Kallen¹, Rima Koka¹, Zeba N Singh¹, Yi Ning¹, Mehmet H Kocoglu^{2

3}, Ashraf Z Badros^{2

3}, Sandrine Niyongere^{2

3}, Vu H Duong^{2

3}, Ashkan Emadi^{2

3}, Maria R Baer^{2

3}

Affiliations

¹ Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States.
² Department of Medicine, Division of Hematology/Oncology, University of Maryland School of Medicine, Baltimore, MD, United States.
³ University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, , United States.

Abstract

New therapies for multiple myeloma have improved outcomes, but are associated with therapy-related hematologic malignancies. We report eight patients with therapy-related B-lymphoblastic leukemias (t-B-ALL) in the setting of therapy for multiple myeloma, which included lenalidomide maintenance. A subset of patients had pancytopenia and low-level marrow involvement by acute leukemia, an unusual finding in de novo B-ALL. One patient died of chemotherapy complications; the other seven responded. No patient died of B-ALL (median follow up of 1.0 years). Our series suggests that t-B-ALL is clonally unrelated to myeloma, presents with diverse cytogenetic abnormalities, and responds well to B-ALL therapy.

Keywords: Lenalidomide; Melphalan; Multiple myeloma (MM); Therapy-related B-lymphoblastic leukemia (t-B-ALL).

Publication types

Case Reports