A 52-year-old woman, previously treated with chemo- and radiotherapy for Hodgkin's disease, developed an acute non-lymphoid leukemia and, contemporarily, an IgG-kappa paraproteinemia. Cytogenetic analysis showed a major clone, representing 90% of observed metaphases, with monosomy of chromosomes 5 and 14. In addition, leukemic cells exhibited a high expression of the P-glycoprotein, a transmembrane glycoprotein involved in the multidrug-resistance mechanism. Possible explanations for this cluster of findings are provided.
Get full access to this article
View all access options for this article.
References
1.
AllenE.L., MetzE.N., BalcerzakS.P.: Acute myelomonocytic leukemia with macroglobulinemia, Bence-Jones proteinuria and hypercalcemia.Cancer, 32: 121–124, 1973.
2.
AtkinsH., DrouinJ., IzaguirreC.A., SengarD.S.: Acute promyelocytic leukemia associated with a paraprotein that reacts with leukemic cells.Cancer, 63: 1750–1751, 1989.
3.
BergsagelD., BaileyA.J., LangleyG.R., McDonaldR.M., WhiteD., MillerA.B.: The chemotherapy of plasma cell myeloma and the incidence of acute leukemia.N. Engl. J. Med., 301: 743–748, 1979.
4.
BrincknerH.: Estimate of overall treatment results in acute nonlympocytic leukemia based on age-specific rates of incidence and complete remission.Cancer Treat. Rep., 69: 5–11, 1985.
HallenJ.: Frequency of M-components in serum of subjects above 70 years and after examination of those with an M-component.Acta Med. Scand., 462(Suppl. 1): 84–85, 1966.
7.
HollandJ.F.: Epidemic acute leukemia.N. Engl. J. Med., 301: 743–748, 1979.
8.
ISCN: An international system for human cytogenetic nomenclature.Birth defects: original article series, vol. 21, no. 1. New York: National Foundation-March of Dimes, 1985.
9.
JohanssonB., MertensF., HeimS., KristofferssonU., MitelmanF.: Cytogenetics of secondary myelodysplasia (sMDS) and acute nonlymphocytic leukemia (sANLL).Eur. J. Haematol., 47: 17–27, 1991.
10.
KaldorJ.M., NicholasE.D., ClarkeE.A.: Leukemia following Hodgkin's disease.N. Engl. J. Med., 322: 7–13, 1990.
11.
KyleR.A.: Monoclonal gammopathy of undetermined significance (MGUS): a review.Clin. Haematol., 11: 123–150, 1982.
Le BeauM., AlbainK.S., LarsonR.A., VerdimanJ.W., DavisE.M., BloughR.R., GolombH.M., RowleyJ.D.: Clinical and cytogenetic correlations in 63 patients with therapy-related myelodysplastic syndromes and acute nonlymphocytic leukemia: further evidence for characteristic abnormalities of chromosomes no. 5 and 7.J. Clin. Oncol.3: 325–345, 1986.
14.
LindquistK.J., RagabA.H., OsterlandC.K.: Paraproteinemia in a child with acute leukemia.Blood, 35: 213–221, 1970.
15.
Lo CocoF., De RossiG., PasqualettiD., LopezM., DiverioD., LatagliataR., FenuS., MandelliF.: CD7-positive acute myeloid leukemia: a subtype associated with cell immaturity.Br. J. Haematol., 73: 480–485, 1989.
16.
MarieJ.P., ZittounR., SikicB.I.: Multidrug resistance (mdr 1) gene expression in adult acute leukemia: correlations with treatment outcome and in vitro drug sensitivity.Blood, 78: 586–592, 1991.
17.
MichelsS.D., McKennaR.W., ArthurD.C.: Therapy-related acute myeloid leukemia and myelodysplastic syndrome. A clinical and morphologic study.Blood, 65: 1364–1372, 1985.
18.
OssermanE.F.: The association between plasmacytic and monocytic dyscrasias in man. In: Clinical and biochemical studies in gamma globulin structure and control biosynthesis, KillanderR. (Ed.), pp. 573–585. Third Nobel Symposium, Stockholm 1967, New York International Publishers, New York, 1986.
19.
PapaG., MauroF.R., AnselmoA.P.: Acute leukemia in patients treated for Hodgkin's disease.Br. J. Haematol., 58: 43–52, 1984.
20.
ParkerA.C.: A case of acute myelomonocytic leukemia associated with myelomatosis.Scand. J. Haematol., 11: 257–260, 1973.
21.
PolakJ.M., Van NoordenS.: Immunocytochemistry.Modern Methods and Applications, 2nd Edn.Wright J. & Sons Ltd, Bristol, England, 1986.
22.
PrchalJ.T., ThrolkmortonD.N., CarrolA.S., FusonE.W., GamsR.A., PrchalS.F.: A common progenitor for human myeloid and lymphoid cells.Nature, 274, 590–591, 1978.
23.
RazI., PolliakA.: Coexistence of myelomonocytic leukemia and monoclonal gammopathy or myeloma. Simultaneous presentation in three patients.Cancer, 53: 83–85, 1984.
24.
SelvinS., LevinL.I., MerrilD.W., WinkelsteinW.Jr.: Selected epidemiologic observations of cell-specific leukemic mortality in the United States 1969–1977.Am. J. Epidemiol., 117: 140–152, 1983.
25.
Van CampB., ReynaertsP., NaetsJ.P., RadlJ.: Transient IgA-lambda paraproteinemia during treatment of acute myelomonoblastic leukemia.Blood, 55: 21–25, 1980.
