A case of newly diagnosed acute myeloid leukemia with multiple myeloma: challenges in diagnosis and treatment

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The pathogenesis, differential diagnosis, and treatment of these patients are still unclear, and currently they are mainly evaluated based on the specific situation of MICM classification. Case report : An 81 year old male with a 2-year history of hypertension was admitted to the hospital for treatment due to recurrent chest tightness and pain for 3 years, which worsened for 1 day. During physical examination, there is obvious chest tightness when lying flat, with general limited mobility, anemic appearance, visible bleeding points on the skin and mucosa, no fever, no liver, spleen, or lymph node enlargement. Bone marrow morphology examination showed active bone marrow hyperplasia, with 28% of primitive cells and weakly positive peroxidase staining; The proportion of plasma cells significantly increased, accounting for 15%; The mature red blood cells are arranged in a prominent shape. At the same time, flow cytometry and bone marrow biopsy revealed two different abnormal cell populations, with 42% being primitive myeloid cells and 10% being abnormally proliferating plasma cells. Serum M protein was detected by serum electrophoresis and immunofixation electrophoresis, and specific reaction precipitation bands were observed with anti IgG and anti LAM. The diagnosis was acute myeloid leukemia with multiple myeloma, and there was no history of malignant disease or special treatment. Treatment and outcome: The patient initially received BCL inhibitor Venetoclax and demethylated drug Azarcytidine for the treatment of acute myeloid leukemia. Subsequently, due to severe cardiac insufficiency caused by coronary atherosclerotic heart disease, the patient could not tolerate the follow-up treatment, and was automatically discharged to the local hospital for life support treatment. Discussion: In the clinical process of diagnosing and treating hematological diseases, it is rare for these two different types of clonal malignant hematological diseases to occur simultaneously. Patient based prospective studies and case series are needed to guide diagnosis and treatment strategies. multiple myeloma acute myeloid leukemia coronary atherosclerotic heart disease venetoclax azacytidine Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Multiple myeloma (MM) and acute myeloid leukemia (AML) are two different clonal malignant hematological diseases, and their correlation is often described as secondary acute myeloid leukemia after treatment for multiple myeloma 1-2 . However, it is a rare coincidence that AML and MM are diagnosed simultaneously in patients without a history of malignant diseases and special treatment. At present, there is little literature describing the simultaneous diagnosis of AML and MM in the same patient, and there is no reference for the pathogenesis, differential diagnosis, and treatment of these patients. Therefore, we hereby report information on a patient who was admitted to the hospital due to chest tightness and pain and was diagnosed with both AML and MM. Case A 81 year old male patient admitted to the Department of Cardiology in our hospital reported recurrent chest tightness and pain for over 3 years, which worsened for 1 day. The patient has a history of hypertension for 2 years, irregular medication use, self reported good blood pressure control, no history of malignant tumors, exposure to chemicals and radiation, and no history of smoking. During physical examination, there is obvious chest tightness when lying flat, with general limited mobility, anemic appearance, visible bleeding points on the skin and mucosa, no fever, no liver, spleen, or lymph node enlargement. In terms of whole blood cell count, there is a decrease in whole blood cells (white blood cells 0.2 × 10 9 /L, red blood cell 1.75 × 10 12 /L, hemoglobin 59g/L, platelets 40 × 10 9 /L). Peripheral blood biochemical examination showed that creatine kinase isoenzyme 26.6ng/mL, myoglobin 136.5ng/mL, N-terminal pro-brain natriuretic peptide 13078pg/mL, troponin 5.367ng/mL, albumin 26.7g/L, globulin 64g/L, lactate dehydrogenase 364IU/L, Ca 2+ 2.02mmol/L. Coronary angiography revealed changes in coronary atherosclerosis, 64% localized moderate stenosis in the left main coronary artery lumen, 75% localized severe stenosis in the proximal lumen of the left anterior descending branch, 65% localized moderate stenosis in the proximal lumen of the left circumflex branch, and 60% localized stenosis in the proximal lumen of the right coronary artery. Due to severe pancytopenia, which is difficult to tolerate due to age, interventional stent surgery is not currently considered. The cause of pancytopenia will be further investigated in the hematology department after hospitalization. Morphological examination of bone marrow cells showed active bone marrow hyperplasia, with 28% of primitive cells and weakly positive peroxidase staining; The proportion of plasma cells significantly increased, accounting for 15%; The arrangement of mature red blood cells is obvious in the shape of roulea (Figure 1). Perform chromosome karyotype analysis and flow cytometry examination on bone marrow aspirates. The detected antigens include HLA-DR, CD3, CD4, CD8, CD10, CD11b, CD13, CD14, CD15, CD19, CD20, CD22, CD27, CD28, CD33, CD34, CD38, CD56, CD64, CD71, CD117, CD123, CD138, cKappa, cLambda, MPO, cCD79a, cCD3, TdT, CD45. The immunophenotype of flow cytometry is of great significance for two abnormal clonal cell populations (Figure 2). Immunophenotype: The first type of positive expression is HLA-DR, CD33, CD34, CD38, CD117, CD123, which is considered AML. The second type of positive expression is CD38, CD117, CD138, and cLambda, which is considered as an abnormal plasma cell proliferative disease. The karyotype analysis is 46, XY [20]. The pathology of bone marrow tissue suggests significant and active proliferation of hematopoietic tissue, with diffuse distribution of immature cells and increased plasma cells (Figure 3). Serum immunofixation electrophoresis and free light chain analysis showed that IgG 61.40g/L (reference value 7.51-15.60g/L), IgM 0.44g/L (reference value 0.46-3.04g/L), IgA 0.60g/L (reference value 0.80-4.53g/L), free kappa 21.90g/L (reference value 6.7-22.4g/L), lambda 54.30g/L (reference value 8.3-27.0g/L), and free kappa/lambda ratio 0.403 (reference value 0.31-1.56), and serum M protein 38.34g/L, The immunofixation test showed the formation of specific reaction precipitation bands with anti IgG and anti LAM (Figure 4). Urinary protein electrophoresis was normal, but immunofixation tests showed a slightly specific reaction precipitate band with anti IgG and anti LAM. The patient's renal function is normal, blood calcium is low, and liver function is slightly abnormal. The N-terminal pro-brain natriuretic peptide precursor 3338pg/mL and cardiac injury marker troponin 0.067ng/mL are significantly reduced compared to before. No osteolytic damage was found during bone examination. According to the diagnostic criteria of the NCCN 2022 guidelines, the patient was diagnosed with concurrent AML and MM. Shortly after the patient's diagnosis, they began receiving BCL inhibitor Vineclavone (100mg on the first day, 200mg on the second day, 400mg from the third day to the end) and demethylated drug azacitidine (75 mg/m2 subcutaneous injection for seven consecutive days). Due to the patient's own underlying coronary heart disease, the patient's heart function worsened on the third day of chemotherapy, and they were unable to continue receiving follow-up treatment. They returned to their local life support treatment with automatic discharge. Discussion This case confirms the simultaneous detection of acute myeloid leukemia and multiple myeloma in a patient without exposure related risk factors, and the main complaint of this admission is recurrent chest tightness, making it difficult to analyze the chronological sequence of the occurrence of the two. However, we can consider that this patient went to the hospital due to severe anemia leading to worsening of heart function, and the disease was diagnosed earlier. The vast majority of patients with multiple myeloma develop gradually from monoclonal immunoglobulin of undetermined significance (MGUS). Clinical observations from MGUS to MM show that patients do not have symptoms such as anemia, bone destruction, hypercalcemia, and renal function damage, only changes in serum M protein and bone marrow plasma cell count 3 . In our case, the patient did not have typical SLimCRAB symptoms of multiple myeloma, such as bone destruction, hypercalcemia, and renal function damage. They only had anemia, but met the requirement for a bone marrow monoclone plasma cell ratio of ≥ 10%, and tissue biopsy and flow cytometry confirmed it as a plasma cell tumor. In the bone marrow extract, it was also confirmed that the proportion of primitive cells was more than that of abnormal monoclone plasma cells. Therefore, we consider that anemia is caused by acute myeloid leukemia. Some scholars have found that the origin of these two clonal diseases may be related to the potential involvement of cytokine IL-6. IL-6 is a key myeloma cell growth factor, and its excessive production is believed to be an anti apoptotic inducer of MM. IL-6 also promotes the generation of megakaryocytes, which may be related to the pathogenesis of myeloproliferative tumors and subsequently lead to AML 4 . Similarly, another study also reported an increase in serum IL-6 levels during relapse after induction therapy in a case of AML and MM, and a decrease of in expression levels after azacitidine treatment 5 . Moreover, Wulf speculated that excessive accumulation of primary myeloid cells producing IL-6 may promote plasma cell proliferation and promote the transition from MGUS to MM 6 . Furthermore, based on recent literature knowledge, the treatment strategies for patients with these two types of clonal blood diseases are uncertain and can only be individualized. In our case, considering the patient's condition, we tend to focus on the changes in AML condition. Therefore, considering the cardiotoxicity of anthracycline drugs and the older age of the patient, as well as research confirming that azacitidine has achieved good efficacy in AML combined with MM, we achieved complete hematological remission within 12 months 7 . We chose the combination therapy of BCL-2 inhibitor Vinetoke and demethylated drug azacitidine, which achieved initial hematological remission in the early stage. However, on the third day of chemotherapy, the patient's cardiac dysfunction worsened and they were unable to continue receiving follow-up treatment. They were automatically discharged and returned to their local area for life support treatment, making it impossible to evaluate the subsequent efficacy. In summary, the prognosis of these patients is often poor, and clinical doctors and pathologists should pay attention to similar cases, and must make a clear diagnosis through flow cytometry, pathological biopsy, and even FISH testing. Patient based prospective research and case reporting communication are the necessary paths to promote standardized diagnosis and treatment of rare cases. Declarations Patient Perspective The patient expresses understanding and support for the treatment without any objections Informed Consent The patient's immediate family is willing to disclose the diagnosis and treatment process and relevant experience of this rare case to promote medical development Competing interests The Authors declare that they have no competing interests. Author Contributions All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Funding information Key R & D plan of Jiangxi Province of China, Grant/Award Number: 20202BBGL73111; Translational Research Grant of NCRCH, Grant/Award Number: 2021WWA02; Central Guidance of Local Science and Technology Development Fund, Grant/Award Number: 20211ZDG02002; National Natural Science Foundation of China, Grant/Award Number: 81560026; References Qian J, Shi W, Yang L, et al. Treatment-related acute granulocyte-monocytic leukemia from multiple myeloma: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(50):e9293. Shoumariyeh K, Jung J, Rassner M, et al. Treatment of therapy-related acute myeloid leukemia and underlying multiple myeloma with decitabine/venetoclax and daratumumab. Ann Hematol. 2021 Jun;100(6):1637-1640. Landgren O, Kyle RA, Pfeiffer RM, et al. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood.2009;113(22):5412–7 Eskazan AE, Ongoren S, Ar MC, et al. Essential thrombocythemia and multiple myeloma: two rare diseases in one patient. Clin Lymphoma Myeloma Leuk. 2011 Oct;11(5):442-5. Oka S, Ono K, Nohgawa M. Successful treatment with azacitidine for the simultaneous occurrence of multiple myeloma and acute myeloid leukemia with concomitant del(5q) and the JAK2 V617F mutation. Ann Hematol. 2017 Aug;96(8):1411-1413. Wulf GG, Jahns-Streubel G, Hemmerlein B, et al. Plasmacytosis in acute myeloid leukemia: two cases of plasmacytosis and increased IL-6 production in the AML blast cells. Ann Hematol 1998; 76: 273–277. Berthon C, Nudel M, Boyle EM, et al. Acute myeloid leukemia synchronous with multiple myeloma successfully treated by azacytidine/lenalidomide and daratumumab without a decrease in myeloid clone size. Leuk Res Rep. 2020 Apr 23;13:100202. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3804387","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":263667265,"identity":"e34b86ff-d5c6-445f-9f67-5c939d7a4862","order_by":0,"name":"Liang Li","email":"","orcid":"","institution":"Department of Clinical Laboratory, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College","correspondingAuthor":false,"prefix":"","firstName":"Liang","middleName":"","lastName":"Li","suffix":""},{"id":263667267,"identity":"b4676ee1-2339-47a5-a556-44615bd5a033","order_by":1,"name":"Haiyun 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However, it is a rare coincidence that AML and MM are diagnosed simultaneously in patients without a history of malignant diseases and special treatment. At present, there is little literature describing the simultaneous diagnosis of AML and MM in the same patient, and there is no reference for the pathogenesis, differential diagnosis, and treatment of these patients. Therefore, we hereby report information on a patient who was admitted to the hospital due to chest tightness and pain and was diagnosed with both AML and MM.\u003c/p\u003e"},{"header":"Case","content":"\u003cp\u003eA 81 year old male patient admitted to the Department of Cardiology in our hospital reported recurrent chest tightness and pain for over 3 years, which worsened for 1 day. The patient has a history of hypertension for 2 years, irregular medication use, self reported good blood pressure control, no history of malignant tumors, exposure to chemicals and radiation, and no history of smoking. During physical examination, there is obvious chest tightness when lying flat, with general limited mobility, anemic appearance, visible bleeding points on the skin and mucosa, no fever, no liver, spleen, or lymph node enlargement.\u003c/p\u003e\n\u003cp\u003eIn terms of whole blood cell count, there is a decrease in whole blood cells (white blood cells 0.2 \u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L, red blood cell 1.75 \u0026times; 10\u003csup\u003e12\u003c/sup\u003e/L, hemoglobin 59g/L, platelets 40 \u0026times; 10\u003csup\u003e9\u003c/sup\u003e/L). Peripheral blood biochemical examination showed that creatine kinase isoenzyme 26.6ng/mL, myoglobin 136.5ng/mL, N-terminal pro-brain natriuretic peptide 13078pg/mL, troponin 5.367ng/mL, albumin 26.7g/L, globulin 64g/L, lactate dehydrogenase 364IU/L, Ca\u003csup\u003e2+\u003c/sup\u003e 2.02mmol/L. Coronary angiography revealed changes in coronary atherosclerosis, 64% localized moderate stenosis in the left main coronary artery lumen, 75% localized severe stenosis in the proximal lumen of the left anterior descending branch, 65% localized moderate stenosis in the proximal lumen of the left circumflex branch, and 60% localized stenosis in the proximal lumen of the right coronary artery. Due to severe pancytopenia, which is difficult to tolerate due to age, interventional stent surgery is not currently considered. The cause of pancytopenia will be further investigated in the hematology department after hospitalization.\u003c/p\u003e\n\u003cp\u003eMorphological examination of bone marrow cells showed active bone marrow hyperplasia, with 28% of primitive cells and weakly positive peroxidase staining; The proportion of plasma cells significantly increased, accounting for 15%; The arrangement of mature red blood cells is obvious in the shape of roulea (Figure 1). Perform chromosome karyotype analysis and flow cytometry examination on bone marrow aspirates. The detected antigens include HLA-DR, CD3, CD4, CD8, CD10, CD11b, CD13, CD14, CD15, CD19, CD20, CD22, CD27, CD28, CD33, CD34, CD38, CD56, CD64, CD71, CD117, CD123, CD138, cKappa, cLambda, MPO, cCD79a, cCD3, TdT, CD45. The immunophenotype of flow cytometry is of great significance for two abnormal clonal cell populations (Figure 2). Immunophenotype: The first type of positive expression is HLA-DR, CD33, CD34, CD38, CD117, CD123, which is considered AML. The second type of positive expression is CD38, CD117, CD138, and cLambda, which is considered as an abnormal plasma cell proliferative disease. The karyotype analysis is 46, XY [20].\u003c/p\u003e\n\u003cp\u003eThe pathology of bone marrow tissue suggests significant and active proliferation of hematopoietic tissue, with diffuse distribution of immature cells and increased plasma cells (Figure 3). Serum immunofixation electrophoresis and free light chain analysis showed that IgG 61.40g/L (reference value 7.51-15.60g/L), IgM 0.44g/L (reference value 0.46-3.04g/L), IgA 0.60g/L (reference value 0.80-4.53g/L), free kappa \u0026nbsp;21.90g/L (reference value 6.7-22.4g/L), lambda 54.30g/L (reference value 8.3-27.0g/L), and free kappa/lambda ratio 0.403 (reference value 0.31-1.56), and serum M protein 38.34g/L, The immunofixation test showed the formation of specific reaction precipitation bands with anti IgG and anti LAM (Figure 4). Urinary protein electrophoresis was normal, but immunofixation tests showed a slightly specific reaction precipitate band with anti IgG and anti LAM.\u003c/p\u003e\n\u003cp\u003eThe patient\u0026apos;s renal function is normal, blood calcium is low, and liver function is slightly abnormal. The N-terminal pro-brain natriuretic peptide precursor 3338pg/mL and cardiac injury marker troponin 0.067ng/mL are significantly reduced compared to before. No osteolytic damage was found during bone examination. According to the diagnostic criteria of the NCCN 2022 guidelines, the patient was diagnosed with concurrent AML and MM. Shortly after the patient\u0026apos;s diagnosis, they began receiving BCL inhibitor Vineclavone (100mg on the first day, 200mg on the second day, 400mg from the third day to the end) and demethylated drug azacitidine (75 mg/m2 subcutaneous injection for seven consecutive days). Due to the patient\u0026apos;s own underlying coronary heart disease, the patient\u0026apos;s heart function worsened on the third day of chemotherapy, and they were unable to continue receiving follow-up treatment. They returned to their local life support treatment with automatic discharge.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case confirms the simultaneous detection of acute myeloid leukemia and multiple myeloma in a patient without exposure related risk factors, and the main complaint of this admission is recurrent chest tightness, making it difficult to analyze the chronological sequence of the occurrence of the two. However, we can consider that this patient went to the hospital due to severe anemia leading to worsening of heart function, and the disease was diagnosed earlier. The vast majority of patients with multiple myeloma develop gradually from monoclonal immunoglobulin of undetermined significance (MGUS). Clinical observations from MGUS to MM show that patients do not have symptoms such as anemia, bone destruction, hypercalcemia, and renal function damage, only changes in serum M protein and bone marrow plasma cell count\u003csup\u003e3\u003c/sup\u003e. In our case, the patient did not have typical SLimCRAB symptoms of multiple myeloma, such as bone destruction, hypercalcemia, and renal function damage. They only had anemia, but met the requirement for a bone marrow monoclone plasma cell ratio of \u0026ge; 10%, and tissue biopsy and flow cytometry confirmed it as a plasma cell tumor. In the bone marrow extract, it was also confirmed that the proportion of primitive cells was more than that of abnormal monoclone plasma cells. Therefore, we consider that anemia is caused by acute myeloid leukemia.\u003c/p\u003e\n\u003cp\u003eSome scholars have found that the origin of these two clonal diseases may be related to the potential involvement of cytokine IL-6. IL-6 is a key myeloma cell growth factor, and its excessive production is believed to be an anti apoptotic inducer of MM. IL-6 also promotes the generation of megakaryocytes, which may be related to the pathogenesis of myeloproliferative tumors and subsequently lead to AML\u003csup\u003e4\u003c/sup\u003e. Similarly, another study also reported an increase in serum IL-6 levels during relapse after induction therapy in a case of AML and MM, and a decrease of in expression levels after azacitidine treatment\u003csup\u003e5\u003c/sup\u003e. Moreover, Wulf speculated that excessive accumulation of primary myeloid cells producing IL-6 may promote plasma cell proliferation and promote the transition from MGUS to MM\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eFurthermore, based on recent literature knowledge, the treatment strategies for patients with these two types of clonal blood diseases are uncertain and can only be individualized. In our case, considering the patient\u0026apos;s condition, we tend to focus on the changes in AML condition. Therefore, considering the cardiotoxicity of anthracycline drugs and the older age of the patient, as well as research confirming that azacitidine has achieved good efficacy in AML combined with MM, we achieved complete hematological remission within 12 months\u003csup\u003e7\u003c/sup\u003e. We chose the combination therapy of BCL-2 inhibitor Vinetoke and demethylated drug azacitidine, which achieved initial hematological remission in the early stage. However, on the third day of chemotherapy, the patient\u0026apos;s cardiac dysfunction worsened and they were unable to continue receiving follow-up treatment. They were automatically discharged and returned to their local area for life support treatment, making it impossible to evaluate the subsequent efficacy.\u003c/p\u003e\n\u003cp\u003eIn summary, the prognosis of these patients is often poor, and clinical doctors and pathologists should pay attention to similar cases, and must make a clear diagnosis through flow cytometry, pathological biopsy, and even FISH testing. Patient based prospective research and case reporting communication are the necessary paths to promote standardized diagnosis and treatment of rare cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003ePatient Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient expresses understanding and support for the treatment without any objections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient\u0026apos;s immediate family is willing to disclose the diagnosis and treatment process and relevant experience of this rare case to promote medical development\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKey R \u0026amp; D plan of Jiangxi Province of China, Grant/Award Number: 20202BBGL73111; Translational Research Grant of NCRCH, Grant/Award Number: 2021WWA02; Central Guidance of Local Science and Technology Development Fund, Grant/Award Number: 20211ZDG02002; National Natural Science Foundation of China, Grant/Award Number: 81560026;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eQian J, Shi W, Yang L, et al. Treatment-related acute granulocyte-monocytic leukemia from multiple myeloma: A case report and literature review. Medicine (Baltimore). 2017 Dec;96(50):e9293.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShoumariyeh K, Jung J, Rassner M, et al. Treatment of therapy-related acute myeloid leukemia and underlying multiple myeloma with decitabine/venetoclax and daratumumab. Ann Hematol. 2021 Jun;100(6):1637-1640.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLandgren O, Kyle RA, Pfeiffer RM, et al. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood.2009;113(22):5412\u0026ndash;7\u003c/li\u003e\n \u003cli\u003eEskazan AE, Ongoren S, Ar MC, et al. Essential thrombocythemia and multiple myeloma: two rare diseases in one patient. Clin Lymphoma Myeloma Leuk. 2011 Oct;11(5):442-5.\u003c/li\u003e\n \u003cli\u003eOka S, Ono K, Nohgawa M. Successful treatment with azacitidine for the simultaneous occurrence of multiple myeloma and acute myeloid leukemia with concomitant del(5q) and the JAK2 V617F mutation. Ann Hematol. 2017 Aug;96(8):1411-1413.\u003c/li\u003e\n \u003cli\u003eWulf GG, Jahns-Streubel G, Hemmerlein B, et al. Plasmacytosis in acute myeloid leukemia: two cases of plasmacytosis and increased IL-6 production in the AML blast cells. Ann Hematol 1998; 76: 273\u0026ndash;277.\u003c/li\u003e\n \u003cli\u003eBerthon C, Nudel M, Boyle EM, et al. Acute myeloid leukemia synchronous with multiple myeloma successfully treated by azacytidine/lenalidomide and daratumumab without a decrease in myeloid clone size. Leuk Res Rep. 2020 Apr 23;13:100202.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"multiple myeloma, acute myeloid leukemia, coronary atherosclerotic heart disease, venetoclax, azacytidine","lastPublishedDoi":"10.21203/rs.3.rs-3804387/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3804387/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: It is a rare coincidence that acute myeloid leukemia and multiple myeloma are diagnosed simultaneously in patients without a history of malignant diseases and special treatment. The pathogenesis, differential diagnosis, and treatment of these patients are still unclear, and currently they are mainly evaluated based on the specific situation of MICM classification.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase report\u003c/strong\u003e: An 81 year old male with a 2-year history of hypertension was admitted to the hospital for treatment due to recurrent chest tightness and pain for 3 years, which worsened for 1 day. During physical examination, there is obvious chest tightness when lying flat, with general limited mobility, anemic appearance, visible bleeding points on the skin and mucosa, no fever, no liver, spleen, or lymph node enlargement. Bone marrow morphology examination showed active bone marrow hyperplasia, with 28% of primitive cells and weakly positive peroxidase staining; The proportion of plasma cells significantly increased, accounting for 15%; The mature red blood cells are arranged in a prominent shape. At the same time, flow cytometry and bone marrow biopsy revealed two different abnormal cell populations, with 42% being primitive myeloid cells and 10% being abnormally proliferating plasma cells. Serum M protein was detected by serum electrophoresis and immunofixation electrophoresis, and specific reaction precipitation bands were observed with anti IgG and anti LAM. The diagnosis was acute myeloid leukemia with multiple myeloma, and there was no history of malignant disease or special treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment and outcome: \u003c/strong\u003eThe patient initially received BCL inhibitor Venetoclax and demethylated drug Azarcytidine for the treatment of acute myeloid leukemia. Subsequently, due to severe cardiac insufficiency caused by coronary atherosclerotic heart disease, the patient could not tolerate the follow-up treatment, and was automatically discharged to the local hospital for life support treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e In the clinical process of diagnosing and treating hematological diseases, it is rare for these two different types of clonal malignant hematological diseases to occur simultaneously. Patient based prospective studies and case series are needed to guide diagnosis and treatment strategies.\u003c/p\u003e","manuscriptTitle":"A case of newly diagnosed acute myeloid leukemia with multiple myeloma: challenges in diagnosis and treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 20:10:01","doi":"10.21203/rs.3.rs-3804387/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e10b6216-a412-4dd9-9f49-f4107f4d8d0d","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-21T12:44:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-02 20:10:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3804387","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3804387","identity":"rs-3804387","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}