197 Coexistence of Multiple Myeloma and Prefibrotic Stage of Primary Myelofibrosis (PMF): A Case Report

Multiple myeloma and myeloproliferative neoplasms are hematologic malignancies with a completely different cellular origin. Coexistence of multiple myeloma and myeloproliferative neoplasms is rare and the underlying mechanism for these two concurrent entities is unknown.

We report a case of a 79-year-old African-American man who presented with anemia and thrombocytosis with a clinical suspicion of primary myelofibrosis (PMF). Analysis of the peripheral blood revealed a JAK2 V617F mutation and a 13q14 deletion. Examination of the bone marrow showed increased plasma cells with flow cytometric documentation of abnormal monotypic plasma cells and FISH evidence of a gain of1q21 and loss of IGH/14q, both characteristic for multiple myeloma. The 13q14 deletion was again documented, but in a minority of cells, presumably contaminating hematopoietic cells. The histological picture was consistent with the prefibrotic phase of primary myelofibrosis and an accompanying plasma cell neoplasm. Additional laboratory findings confirmed symptomatic plasma cell myeloma.

At present, management is focused on treating the myeloma and monitoring the MPN. The interaction of megakaryocytes and plasma cells is well documented in myeloma. The possibility that one created a microenvironment conducive to the full-blown development of the other cannot be excluded.