Refractory chronic lymphocytic leukemia with concomitant extramedullary multiple myeloma with lymph node involvement

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Abstract

Concomitant chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in the same patient is extremely rare. In this report, we present an unprecedented case of a patient with a history of progressive, purine analog-resistant CLL, who developed extramedullary malignant plasmacytic infiltrates in lymph nodes on the background of preexisting CLL lesions, presenting with clinical sequelae attributable to active MM (hypercalcemia, renal insufficiency, anemia, bone lesions). We administered R-CHOP with bortezomib with partial remission and both CLL and MM relapsed after one month. Our patient deceased three months later. Surprisingly first bone marrow trephine biopsy did not reveal plasmacytic infiltration. However combination of symptoms presented by our patient should always be an indication for repeating biopsy. Early detection of aggressive multiple myeloma can improve prognosis and prolong survival.
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难治性慢性淋巴细胞白血病合并淋巴结受累的髓外多发性骨髓瘤
同一患者同时患有慢性淋巴细胞白血病(CLL)和多发性骨髓瘤(MM)的情况极为罕见。在本报告中,我们发现了一例史无前例的病例,患者曾患有进展性、嘌呤类似物耐药的 CLL,在原有 CLL 病变的背景下,淋巴结出现髓外恶性浆细胞浸润,并伴有活动性 MM 的临床后遗症(高钙血症、肾功能不全、贫血、骨病变)。我们给予硼替佐米联合 R-CHOP 治疗,患者病情部分缓解,但一个月后 CLL 和 MM 均复发。三个月后,我们的病人去世了。令人惊讶的是,第一次骨髓穿刺活检并未发现浆细胞浸润。然而,我们的患者所出现的综合症状始终是重复活检的指征。早期发现侵袭性多发性骨髓瘤可以改善预后,延长生存期。
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审稿时长
96 days
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