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Am J Clin Pathol ; 154(6): 816-827, 2020 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-32880627

RESUMO

OBJECTIVES: Autologous stem cell transplant with lenalidomide maintenance therapy has greatly improved the relapse-free and overall survival rates of patients with multiple myeloma but also has been associated with an increased risk of secondary B-lymphoblastic leukemia/lymphoma (B-ALL). METHODS: We report a comprehensive review of the clinicopathologic features of 2 patients with multiple myeloma who developed secondary B-ALL during lenalidomide maintenance. RESULTS: Our observations showed that the disease may initially present with subtle clinical, morphologic, and flow-cytometric findings. The flow cytometry findings in such cases may initially mimic an expansion of hematogones with minimal immunophenotypic variation. Both patients achieved complete remission of secondary B-ALL after standard chemotherapy; however, one patient continues to have minimal residual disease, and the other experienced relapse. Next-generation sequencing of the relapse specimen showed numerous, complex abnormalities, suggesting clonal evolution. CONCLUSIONS: Our findings suggest the need for increased awareness and further study of this unique form of secondary B-ALL.


Assuntos
Fatores Imunológicos , Lenalidomida/efeitos adversos , Mieloma Múltiplo/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras B/induzido quimicamente , Adulto , Antineoplásicos/uso terapêutico , Medula Óssea/química , Medula Óssea/patologia , Análise Citogenética , Evolução Fatal , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lenalidomida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Recidiva , Indução de Remissão , Transplante de Células-Tronco
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