melphalan and Muscle-Weakness

Therapy-related acute myeloid leukemias arise as a result of cytotoxic chemotherapy and/or radiation therapy. The most common types of acute myeloid leukemia arising in this setting are acute myeloid leukemia with maturation, and lesser numbers of acute myelomonocytic leukemia, acute monocytic leukemia, acute erythroleukemia, or acute megakaryocytic leukemia. We present a patient with multiple myeloma who was treated with melphalan and 4 years later developed acute erythroid leukemia. The morphologic diagnosis of pure erythroid leukemia developing in the setting of multiple myeloma may be challenging.

Topics: Acute Disease; Aged, 80 and over; Antineoplastic Agents, Alkylating; Epistaxis; Humans; Leukemia, Erythroblastic, Acute; Leukemia, Myeloid; Male; Melphalan; Multiple Myeloma; Muscle Weakness

At age of 57 years, a man experienced an episode of rhabdomyolysis. On that occasion muscle biopsy was not performed, however monoclonal gammopathy of undetermined significance (MGUS) was diagnosed. Further he developed a moderate proximal muscle weakness with CK level persistently elevated (1000-1200U/l). When he came to our observation, at age 67, a muscle biopsy revealed an amyloid myopathy and multiple myeloma was at the same time disclosed. Terminal complement complex C5b9 (membrane attack complex) deposits were found in the vessel walls and muscle fibers surface depicted by amyloid. Our case suggests to keep in mind the possibility that amyloid myopathy may begin as an isolate episode of rhabdomyolysis. The detection of complement complex C5b9 suggests that complement cascade is implicated in the muscular damage of amyloid myopathy.

Topics: Aged; Amyloidosis; Betamethasone; Biopsy; Blood Vessels; Complement Membrane Attack Complex; Complement System Proteins; Creatine Kinase; Glucocorticoids; Humans; Male; Melphalan; Muscle Weakness; Muscle, Skeletal; Muscular Diseases; Myeloablative Agonists; Rhabdomyolysis; Treatment Outcome