Korean J Hematol.  2007 Jun;42(2):151-156. 10.5045/kjh.2007.42.2.151.

A Case of Chronic Neutrophilic Leukemia with Multiple Myeloma and an Increased Function of Her Neutrophils

• Kim S
• Park CJ
• Lee KH
• Jang S
• Chi HS
• Seo EJ

• KMID: 2083513
• DOI: http://doi.org/10.5045/kjh.2007.42.2.151

Abstract

We describe here a 64-year-old woman who simultaneously presented with chronic neutrophilic leukemia (CNL) and multiple myeloma (MM). The patient presented with mature neutrophilic leukocytosis, hepatosplenomegaly, the absence of Philadelphia chromosome and the BCR-ABL fusion gene, along with IgG kappa type monoclonal gammopathy in her serum and urine. The bone marrow aspirates showed hypercellularity with marked granulocytic hyperplasia and an increase in immature plasma cells. The neutrophil function tests showed increased phagocytosis, chemotaxis and respiratory burst activity, but there was normal microbial killing activity. The patient was treated with dexamethasone and pamidronate for MM and with hydroxyurea for CNL, and she was discharged from the hospital in an improved condition.

Keyword

Chronic neutrophilic leukemia; Multiple myeloma; Neutrophil function test

MeSH Terms

Bone Marrow
Chemotaxis
Dexamethasone
Female
Homicide
Humans
Hydroxyurea
Hyperplasia
Immunoglobulin G
Leukemia, Neutrophilic, Chronic*
Leukocytosis
Middle Aged
Multiple Myeloma*
Neutrophils*
Paraproteinemias
Phagocytosis
Philadelphia Chromosome
Plasma Cells
Respiratory Burst
Dexamethasone
Hydroxyurea
Immunoglobulin G

Figure

• 

  Fig. 1 Peripheral blood and bone marrow findings in the patient showing coexistence of chronic neutrophilic leukemia and multiple myeloma. (A) Neutrophilia, toxic changes of neutrophils and rouleaux formation of red cells in peripheral blood (Wright stain, ×400). (B) Markedly increased granulocytic series and frequent plasmablasts and plasma cells in bone marrow aspirate (Wright stain, ×400). (C) Hypercellular marrow with granulocytic hyperplasia and increased plasmablasts and plasma cells (H&E stain, ×400).

• 

  Fig. 2 Immunofixation electrophoresis shows IgG kappa type monoclonal gammopathy in serum (A) and IgG kappa and free kappa type Bence-Jones proteinuria in urine (B). SPE, serum protein electrophoresis; UPE, concentrated urine electrophoresis.

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