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

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.