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2020년 제 71차 대한내과학회 추계학술대회
￭S-562 ￭ A case of multiple myeloma following myelodysplastic syndrome
계명대학교 동산의료원 혈액종양내과 이건영, 허미화, 이강국, 김혜라, 김진영, 도영록
Introduction: Myelodysplastic syndrome (MDS) and multiple myeloma (MM) are hematologic malignancies usually occurred in old age patients. Coexistence of both diseases is uncommon and MM following MDS is extremely rare. Here we present an unusual case of MM following MDS.
Case Report: A 76-year old man visited hospital presenting general weakness for a week. His blood test showed pancytopenia; WBC 2,210/㎕, neutrophil 53.2%, Hb 10.2g/dL, Platelet 34,000/㎕. Bone marrow aspiration showed hypocellular marrow with dysplasia such as bi-nucleation/multi-nucleation and internuclear bridging over 10% of erythroid cells. Myelodysplastic syndrome with single lineage dysplasia (MDS-SLD) was diagnosed. The International Prognostic Scoring System (IPSS) risk category was low; blast <1%
and good cytogenetic; 46, XY, del(20q). He did not have treatment for MDS with routine blood test every three months. After two years, he presented dyspnea. Follow up lab showed aggravated pancytopenia and reversed albumin/globulin ratio; WBC 2,920/㎕, neutrophil 54.5%, Hb 6.9g/dL, Platelet 22,000/㎕, total protein 8.7g/dL, albumin 3.3g/dL. Blood smear presented rouleaux formation. About 60%
of all nucleated elements were atypical plasma cells in bone marrow biopsy. Serum protein electrophoresis showed increased portion of gamma globulin, 3.1g/dL, and serum immune fixation essay showed monoclonal gammopathy; IgG, lambda type. MM following MDS was diagnosed. The second karyotype was identical with first cytogenetics result; 46, XY, del(20q).
Results: He started lenalidomide and dexamethasone chemotherapy for MM and is showing much more improvement in his symptom and blood test especially anemia. After two cycles of chemotherapy, complete remission of MM was achieved.
Conclusion: Coexistence of MDS and MM is rare and limited number of cases is reported. Moreover, MDS followed by MM is extremely rare. This patient’s symptom was atypical but redoing bone marrow study helped early diagnosis of MM. We have to be aware of patients with MDS if they present new symptom. Then redoing bone marrow study to rule out secondary hematologic malignancy must be considered for appropriate treatment.
