Case Reports in Hematology / 2018 / Article / Tab 1

Case Report

Acute Lymphoblastic Leukemia following Lenalidomide Maintenance for Multiple Myeloma: Two Cases with Unexpected Presentation and Good Prognostic Features

Table 1

Characteristics of patients with multiple myeloma who were exposed to IMiDs maintenance and developed acute lymphoblastic leukemia as a second primary malignancy.

Reference numberIMiD typeTime to Dx (mo)Age (Y)/sex /presentationMorphologic typeCytogenetics/FISHTreatment/outcome

[15]Len12062/F/pancytopeniaB cell (CD19, 20, 10, 22, 79a, TdT, IgMc+, and CD34−)NormalDeath due to septicemia during induction
[16]Len266/M/fatigue, low WBCB cell (CD45, 19, 22, 34+, CD79±, TdT+)Trisomy 4Death 8 mo with no response to induction with CHOP
Thal31
[17]Len13059/M/fatigue, pancytopeniaB cell (CD10, 19+, CD79a, Pax5, and TdT±)Deletion 20qLinker regimen, alive > 1 y after allo-SCT in CR
[17]Len3634/M/pancytopenia and circulating blastsB cell (CD10, 19, 22, 34, 79a, 38+)Chr 14 rearrangementCALGB 8811, death 1 month after induction due to CVS and septicemia
[17]Len18453/M/leukopeniaB cell (CD19, 34, 79a, PAX5, TdT+)Small population of tetraploid cells by FISHLinker regimen, >1 y after 2nd ASCT in CR
[18]Thal1,22961/F/pancytopeniaB cell (CD19, 38+)NACALGB 9111
[19]Len14.565/F/dizzinessB cell (CD19, 22, 34, 79a+, HLA-DR+)NANo treatment, death after 14 mo
Thal32.5
[19]Thal3263/M/fatigue, cytopeniasB cell (CD10, 34+, HLA-DR, and CD33 dim)NALost to follow-up
[19]Thal17333/F/cough, fatigue and anemiaB cell (CD10, 34, 19, 22, 33, 79a+, HLA-DR+)NANo treatment, lost to follow-up
[20]Thal5356/F/edema and dyspnea, pancytopeniaB cell (CD19, 20, 22, 10+, HLA-DR+)NormalSteroids only, DVT/PE, death within 10 days
[21]Len24–3672/M/pancytopeniaB cell (CD10, 19, 20, 79a, and TdT+, CD34, 117, 38, 56−)NAHyper-CVAD, POMP maintenance. CR for 26 mo, then relapse
Our caseLen12369/F/noneB cell (CD34, 19, 22+)t(7;19) in one metaphaseHyper-CVAD, then POMP maintenance, in CR for 3 year
Our caseLen17253/F/pancytopeniaB cell (CD19, 33, 34, 38, 79a+, PAX5+, TdT+)+8, +10, +22, −20, and FISH showed MYC and IgH gene locus copy gainAbbreviated CALGB 8811 due to intolerance, now on POMP maintenance, in CR for 1 year

1These patients had prior ASCT, while the others did not; 2developed ALL 3 years after stopping Thal maintenance.

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