SHM Converge Scientific Abstract ePoster Gallery-Multiple Myeloma Therapy-Related B-Cell Acute Lymphoblastic Leukemia: A Case Series

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This case series describes three patients who developed secondary B-cell acute lymphoblastic leukemia (B-ALL) after treatment for multiple myeloma (MM). All three received standard MM therapy that included high-dose melphalan followed by autologous stem cell transplant (MEL-ASCT) and prolonged maintenance lenalidomide, with B-ALL appearing 33 to 57 months after lenalidomide exposure.<br /><br />The patients had different MM subtypes and risk levels, but each later presented with new abnormalities such as pancytopenia, persistent neutropenia, or leukocytosis. Bone marrow and molecular testing showed Philadelphia chromosome–negative B-ALL in all cases, consistent with prior reports that therapy-related B-ALL after MM is usually Ph-negative. Additional findings included TP53 mutations/deletions and IKZF1 deletion in one patient, suggesting a possible clonal evolution mechanism.<br /><br />Treatment for the secondary leukemia varied and included regimens such as doxorubicin/vincristine, HyperCVAD, vincristine/dexamethasone, and inotuzumab, with one patient also receiving blinatumomab and allogeneic stem cell transplant. Outcomes were mixed: one patient died from infection-related complications, one achieved complete response after allogeneic transplant, and one showed no evidence of leukemia on repeat marrow biopsy.<br /><br />The report emphasizes that therapy-related lymphoblastic leukemia is a rare but serious secondary malignancy in MM survivors, particularly after MEL-ASCT and long-term lenalidomide. Clinicians should evaluate MM patients with new constitutional symptoms or unexplained blood count or marrow abnormalities for possible secondary primary malignancies, including the uncommon possibility of B-ALL.

Asset Subtitle

Aaron Trando

Meta Tag

Author List Aaron Trando, Ah-Reum Jeong, Edward Ball, Richard Wong, Tiffany Tanaka

Category Clinical Vignettes

Concept Multiple Myeloma

Concept Therapy-related B-ALL

Concept Melphalan Autologous Stem Cell Transplant

Concept Lenalidomide Maintenance

Concept Philadelphia Chromosome

Distinguished Non-Finalist

Presenter Organization University of California San Diego School of Medicine

Presenting Author Aaron Trando

Track Adult

Keywords

multiple myeloma

secondary B-cell acute lymphoblastic leukemia

therapy-related leukemia

lenalidomide exposure

autologous stem cell transplant

melphalan

Philadelphia chromosome negative

pancytopenia

TP53 mutation

IKZF1 deletion

Multiple Myeloma

Therapy-related B-ALL

Melphalan Autologous Stem Cell Transplant

Lenalidomide Maintenance

Philadelphia Chromosome