ABSTRACT
We report a case of a patient with IgA kappa multiple myeloma (MM) mobilized with etoposide and subsequently receiving high-dose melphalan (HDM) with stem cell support. She relapsed rapidly post transplantation. Southern blot and fluorescent in situ hybridization analysis showed MLL gene rearrangement in the myeloma cells, which was not detected in the sample at diagnosis or in the PBSC harvested with etoposide plus G-CSF. These observations suggest that clonal rearrangement of the MLL gene is caused by etoposide. Patients with MM undergoing HDM with stem cell rescue may be at an increased risk of not only secondary leukemia, but also secondary genetic abnormalities in myeloma cells, especially those receiving priming with etoposide for peripheral blood stem cell collection.
Subject(s)
Etoposide/adverse effects , Multiple Myeloma/genetics , Multiple Myeloma/therapy , Antineoplastic Agents, Phytogenic/administration & dosage , Antineoplastic Agents, Phytogenic/adverse effects , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cell Division/drug effects , Cytogenetic Analysis , Etoposide/administration & dosage , Female , Gene Rearrangement/drug effects , Hematopoietic Stem Cell Transplantation , Humans , Middle Aged , Multiple Myeloma/pathology , Plasma Cells/drug effects , Plasma Cells/pathology , Recurrence , Transplantation, AutologousSubject(s)
DNA-Binding Proteins/genetics , Gonadal Dysgenesis/veterinary , Horse Diseases/genetics , Nuclear Proteins , Sex Chromosome Aberrations/veterinary , Transcription Factors , Y Chromosome , Animals , DNA Primers/chemistry , Estradiol/blood , Female , Follicle Stimulating Hormone/blood , Gonadal Dysgenesis/genetics , Gonadal Dysgenesis/metabolism , Horse Diseases/metabolism , Horses , Inhibins/blood , Karyotyping/veterinary , Luteinizing Hormone/blood , Polymerase Chain Reaction/veterinary , Progesterone/blood , Sex Chromosome Aberrations/genetics , Sex Chromosome Aberrations/metabolism , Sex-Determining Region Y Protein , Testosterone/bloodABSTRACT
Morphologic and cytochemical features of 30 acute myeloid leukemia subtype M2 (AML-M2) patients with t(8;21) were compared with those of 50 AML-M2 patients without t(8;21). It was disclosed that irregular nuclear shape, Auer bodies, and at least 90% myeloperoxidase positivity in blast cells, and pseudo-Pelger-Huët anomaly of the nuclei and homogeneous pink-colored cytoplasm of mature neutrophils were observed in 90-100% of the t(8;21)+ patients. The percentages of patients showing these features were significantly (P < 0.01) lower in the t(8;21)- group. Among these morphological features, homogeneous pink-colored cytoplasm of mature neutrophils is most characteristic of t(8;21)+ AML-M2, because it was seen in 90% of the t(8;21)+ patients but in only 2% of the t(8;21)- patients. Conversely, pale-colored cytoplasm without any granules in mature neutrophils or dyserythropoietic features was observed in 84% of the t(8;21)- patients, but in none of the t(8;21)+ patients. These data suggest that it is possible to subtype AML-M2 patients morphologically by the recognition of homogeneous pink-colored or pale-colored cytoplasm of mature neutrophils and dyserythropoietic features. Thus, the morphologic subtyping of AML-M2 can be utilized alone or in combination with chromosomal or molecular subtyping for biological and clinical studies of AML with maturation.
