Though multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) have overlapping epidemiologic features and originate from mature B cells, the simultaneous occurrence of both cancers is rare, and data on clinical outcomes and the management of these concurrent disease are limited.
At the 2016 ASH Meeting on Hematologic Malignancies, Bhagirathbhai Dholaria, MBBS, of the Division of Hematology at the Mayo Clinic in Jacksonville, Florida, presented results from a retrospective analysis of clinical and treatment outcomes among patients with both MM and CLL/small lymphocytic lymphoma (SLL).
“We wanted to know how frequently this happens,” Dr. Dholaria said, in an interview with ASH Clinical News, “and if this concurrent or subsequent occurrence of CLL in patients with myeloma changes the clinical course or treatment outcomes for myeloma.” In these cases, he added, “myeloma is the worst of these two malignancies.”
Dr. Dholaria and colleagues identified 10,735 patients with MM who were treated at the Mayo Clinic between 2000 and 2015. Twenty-eight of these patients (.26%) were found to have both MM and CLL (n=15; 54%) or small lymphocytic leukemia (n=13; 46%). The authors compared these subjects to a control group of 56 patients who had a MM diagnosis within 12 months and a birthdate within five years of their matched study patients.
Of the patients with dual diagnoses:
- 15 (53%) had a diagnosis of CLL/SLL before MM was diagnosed (median duration between diagnoses = 25 months)
- 11 (39%) received their diagnoses simultaneously
- 2 (8%) developed CLL after the MM diagnosis
Most had low-risk CLL (defined by fluorescence in situ hybridization): four patients in the high-risk category (20%), 14 in the low-risk category (60%), and four patients in the very-low-risk category (20%).
Light chain restriction between CLL and MM clones were the same in 14 patients (53%) and different in 12 patients (46%). Ultimately, the authors did not find a definite clonal relationship between CLL and MM.
Dr. Dholaria noted that “CLL-directed therapy was not required, and CLL responded to myeloma therapy in all patients, due to overlapping activity of novel agents,” the authors concluded.
Forty-three percent of patients (n=10) had complete remission of CLL after MM therapy, while the rest achieved partial remission or stable disease.
Also, while a diagnosis of both MM and CLL appeared to be associated with shorter median overall survival (OS) compared with those who had a diagnosis of MM alone, this difference was not statistically significant (58 months versus 84 months; p=0.61). See TABLE for all clinical characteristics and treatment outcomes.
Dr. Dholaria noted that, while “consecutive or synchronous development of CLL in MM is a rare occurrence,” the prevalence of CLL was higher in MM patients compared with the general population (0.05%).
Dholaria B, Agarwal A, Roy V, et al. Outcomes of patients with combined chronic lymphocytic leukemia and multiple myeloma. Abstract #89635. Presented at the ASH Meeting on Hematologic Malignancies, September 16-17, 2016; Chicago, IL.
|TABLE. Clinical Characteristics and Treatments|
|Multiple Myeloma and CLL(n=28)||Multiple Myeloma Alone(n=56)||p Value|
|Age||57-87 years(median = 68 years)||57-81 years(median = 67 years)||0.258|
|Follow-up||1.2-127.6 months(median = 44 months)||5.3-134.8 months(median = 40 months)||0.60|
|History of MGUS||9(32%)||9(16%)||0.15|
|I||9 (33%)||4 (14%)||0.73|
|II||7 (25%)||10 (36%)|
|III||11 (41%)||10 (36%)|
|FISH risk group|
|High||4 (15%)||4 (14%)||0.36|
|Intermediate||1 (4%)||4 (14%)|
|Standardized||22 (81%)||20 (71%)|
|First-line PI||8 (30%)||11 (39%)||0.57|
|First-line IMiD||12 (44%)||22 (78%)||0.01|
|AHCT||12 (43%)||13 (46%)||0.78|
|Median survival||58 months||84 months||0.61|
|CLL = chronic lymphocytic leukemia; MGUS = monoclonal gammopathy of undetermined significance; ISS = International Staging System; N/A = not available; FISH = fluorescence in situ hybridization; PI = proteasome inhibitor; IMiD = immunomodulatory drug; AHCT = autologous hematopoietic cell transplant|