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High-dose melphalan produces favorable response in a patient with multiple myeloma and coexisting essential thrombocythemia with JAK2 mutation

Bone Marrow Transplantation volume 49, pages 148–149 (2014)Cite this article

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We report a patient with coexistence of multiple myeloma and preceding essential thrombocythemia (ET) who underwent successful stem cell mobilization and autologous hematopoietic cell transplantation. A 54-year-old Caucasian woman was diagnosed with Durie–Salmon stage 3A multiple myeloma in 2009. Thirteen years prior to the myeloma presentation, she developed myocardial infarction for which she underwent angioplasty and coronary artery stenting. She was started on ticlopidine; however, she developed thrombotic thrombocytopenic purpura with associated renal failure. She received plasmapheresis and short-term hemodialysis with eventual resolution of renal failure. Ten years prior to the myeloma presentation, she was diagnosed with ET with reported platelet counts in the 800 × 103/μL range. Bone marrow biopsy showed hypercellular marrow (70% cellularity) with an increased number of megakaryocytes and hyperlobation, hyperchromasia and separated nuclei. She had undergone vascular surgeries as well as thrombolysis and anticoagulation with warfarin for peripheral arterial disease. Her ET was managed with hydroxyurea for 5 years prior to myeloma presentation.

One year prior to the diagnosis of myeloma, she suffered a vertebral fracture following trauma requiring kyphoplasty of the T11 vertebra. Subsequent workup revealed mild hypercalcemia with calcium of 10.7 mg/dL (upper limit of normal: 10.2 mg/dL). Serum protein electrophoresis did not detect monoclonal protein but serum immunofixation electrophoresis showed kappa light chain. Urine protein electrophoresis showed 11 mg/24 h of kappa free light chain. A bone marrow biopsy was performed, which showed 70% kappa-restricted plasma cell involvement. Cytogenetics showed a normal female karyotype and a myeloma FISH panel was normal. Skeletal survey showed multiple vertebral compression fractures. She was treated with a combination regimen of lenalidomide, bortezomib and dexamethasone. Bone marrow biopsy after eight cycles of chemotherapy showed less than 1% polyclonal plasma cells by flow cytometry and marked megakaryocytic hyperplasia, consistent with complete response from the myeloma standpoint; but with an ongoing chronic myeloproliferative neoplasm. She was found to harbor the JAK2 V617F mutation at 10% allele burden. Pre-transplant platelet count ranged from 334 × 103 to 444 × 103/μL (normal range, 143 to 382 × 103/μL).

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Acknowledgements

We thank Robert Boudreaux for editorial assistance.

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Authors and Affiliations

  1. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    T Nishihori, M Alsina & M A Kharfan-Dabaja

  2. Department of Oncological Sciences, H. Lee Moffitt Cancer Center/University of South Florida College of Medicine, Tampa, FL, USA

    T Nishihori, M Alsina & M A Kharfan-Dabaja

  3. Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon

    Y Hassoun

  4. Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    L Zhang

  5. Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    K Shain

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  1. T Nishihori
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Correspondence to T Nishihori.

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Nishihori, T., Hassoun, Y., Zhang, L. et al. High-dose melphalan produces favorable response in a patient with multiple myeloma and coexisting essential thrombocythemia with JAK2 mutation. Bone Marrow Transplant 49, 148–149 (2014). https://doi.org/10.1038/bmt.2013.117

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