PMC5752996_01
Morphological changes in myeloma cells immediately after the development of plasma cell leukemia. The WBC count was 20.2 x 109/L, and 79.5% of them were composed of typical myeloma cells (1,000x, May-Grunwald-Giemsa staining).
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In December 2009, after seven courses of MPT therapy, the patient developed secondary PCL (Figure 1).
Morphological changes in myeloma cells seven days after initiating bortezomib and dexamethasone. The WBC count was elevated to 48.5 x 109/L, and 95% of them were composed of medium-sized atypical lymphoid cells with multilobated nuclei (1,000x, May-Grunwald-Giemsa staining).
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BD (bortezomib 1.3 mg/m2, days 1, 4, 8, 11 and dexamethasone 20 mg, days 1, 2, 4, 5, 8, 9, 11, 12 of 21) therapy was immediately initiated; however, only 7 days after, laboratory data revealed an increased WBC count (48.5 x 109/L) with approximately 95% of them being medium-sized atypical lymphoid cells with multilobated nuclei (Figure 2).
Morphological changes in myeloma cells two months after the development of secondary plasma cell leukemia. The diameter of the myeloma cells in the bone marrow significantly enlarged by approximately twofold, and pleomorphic nuclei and vacuoles in the cytoplasm were observed, indicating a transformation into anaplastic myeloma (1,000x, May-Grunwald-Giemsa staining).
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Adriamycin, and dexamethasone) and 4 subsequent courses of MMCP (ranimustine, melphalan, cyclophosphamide, and prednisolone), the patient's condition continuously deteriorated further, and he eventually died 4 months after developing PCL. Approximately 2 months before he died, the diameter of myeloma cells in the bone marrow increased twofold, and pleomorphic nuclei and vacuoles in the cytoplasm developed (Figure 3), indicating a transformation into anaplastic myeloma.