melphalan and Leukocytosis

A 68-year-old man was diagnosed as having bronchial asthma in November 1996. He presented with leukocytosis in June 2002. The WBC count was 29,900/microliter with 82% mature neutrophils showing toxic granules. The neutrophil alkaline phosphatase score and serum level of vitamin B12 were elevated. Bone marrow demonstrated myeloid hyperplasia and plasmacytosis. Cytogenetic and molecular analyses were negative for Philadelphia chromosome and BCR/ABL fusion gene. Lambda-type Bence-Jones protein was detected on the serum and urinary immunoelectrophoresis. The coexistence of chronic neutrophilic leukemia and myeloma was suspected based on the clinical features. The serum level of granulocyte-colony stimulating factor (G-CSF) was elevated. Immunohistochemically, atypical plasma cells were positive for anti G-CSF antibody. Finally, we diagnosed this patient as having a G-CSF-producing myeloma. Treatment with melphalan and prednisolone was initiated without beneficial response. He was then admitted to our hospital for ROAD therapy (ranimustine, vincristine, melphalan, and dexamethasone). The neutrophil count decreased in parallel with the serum G-CSF level. These observations indicated that the neutrophilia in this case was probably caused by a reactive response to G-CSF secreted from the myeloma cells.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Dexamethasone; Diagnosis, Differential; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Neutrophilic, Chronic; Leukocytosis; Male; Melphalan; Multiple Myeloma; Neutrophils; Nitrosourea Compounds; Treatment Outcome; Vincristine

A case of a 70 years old female who developed multiple myeloma during a course of neutrophilia, and later on terminated with acute monocytic leukemia (AML, M 5 b) following Melphalan therapy for five years is reported. This patient was first found to have neutrophilia in 1966, After six years, she developed monoclonal gammopathy, (IgG1 kappa type) which coexisted with the neutrophilia. She was put on Melphalan regimen for 5 years which was discontinued due to anemia, leukocytopenia and the reduction of serum IgG. By routine bone marrow examination, she was diagnosed as AMoL (AML, M 5 b) in July 1984. Thereafter, a combination chemotherapy of BH-AC, 6-MP and prednisolone was started and complete remission for the AMoL was achieved after 2 months. Sixteen months later, she relapsed and a similar combination chemotherapy for reinduction regimen was administered. However, the AMoL was resistant and after 7 months, she died of pneumonia and multiple organ failure. The association of neutrophilia with multiple myeloma, the occurrence of AMoL after prolonged Melphalan therapy for the multiple myeloma and the strategy of therapy for secondary leukemia is discussed.

Topics: Aged; Chronic Disease; Female; Humans; Leukemia, Monocytic, Acute; Leukocytosis; Melphalan; Multiple Myeloma; Neutrophils

Topics: Cryoglobulins; Crystallization; Diagnosis, Differential; Female; Humans; Immunoglobulin G; Leukocyte Count; Leukocytosis; Melphalan; Middle Aged; Purpura; Skin Ulcer; Temperature

Topics: Adult; Aged; Blood Cell Count; Blood Platelets; Bone Marrow Examination; Female; Hematemesis; Hematocrit; Hemoglobinometry; Humans; Leukocytosis; Male; Megakaryocytes; Melena; Melphalan; Middle Aged; Postoperative Complications; Splenectomy; Thrombocythemia, Essential; Thrombocytosis

Topics: Bence Jones Protein; Blood Protein Electrophoresis; Bone Marrow Examination; Diagnosis, Differential; Female; gamma-Globulins; Humans; Infarction; Leukemia, Plasma Cell; Leukocytosis; Melphalan; Middle Aged; Multiple Myeloma; Neoplasm Metastasis; Plasma Cells; Prednisone; Spleen; Splenic Neoplasms; Splenic Rupture; Subarachnoid Hemorrhage; Thrombocytopenia

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antineoplastic; Bacteria; Chemistry Techniques, Analytical; Guinea Pigs; Leukocytes; Leukocytosis; Leukopenia; Melphalan; Mice; Phosphines; Polarography; Rabbits; Rats; Streptomyces