Lenalidomide-Associated Secondary B-Lymphoblastic Leukemia/Lymphoma—A Unique Entity

Author:

Germans Sharon Koorse1,Kulak Ozlem1,Koduru Prasad2,Oliver Dwight2,Gagan Jeffery2,Patel Prapti3,Anderson Larry D3,Fuda Franklin S1,Chen Weina1,Jaso Jesse Manuel1

Affiliation:

1. Department of Pathology, University of Texas Southwestern Medical Center, Dallas

2. Department of Genomics and Molecular Pathology, University of Texas Southwestern Medical Center, Dallas

3. Department of Internal Medicine, Hematology and Oncology Division, University of Texas Southwestern Medical Center, Dallas

Abstract

Abstract 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.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

Reference48 articles.

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