Lenalidomide-Associated Secondary B-Lymphoblastic Leukemia/Lymphoma—A Unique Entity A Report of Two Cases with Low-Level Bone Marrow Involvement and Review of the Literature

Sharon Koorse Germans, Ozlem Kulak, Prasad Koduru, Dwight Oliver, Jeffery Gagan, Prapti Patel, Larry D. Anderson, Franklin S. Fuda, Weina Chen, Jesse Manuel Jaso

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)816-827
Number of pages12
JournalAmerican journal of clinical pathology
Volume154
Issue number6
DOIs
StatePublished - Dec 1 2020

Keywords

  • B-lymphoblastic leukemia
  • Lenalidomide
  • Multiple myeloma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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