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

Sollip Kim; Chan-Jeong Park; Kyoo Hyung Lee; Seongsoo Jang; Hyun Sook Chi; Eul-Ju Seo

doi:10.5045/kjh.2007.42.2.151

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Kim, Park, Lee, Jang, Chi, and Seo: A Case of Chronic Neutrophilic Leukemia with Multiple Myeloma and an Increased Function of Her Neutrophils

Case Report

Korean J Hematol 2007;42(2):151-156.

Published online: 19 June 2007

DOI: https://doi.org/10.5045/kjh.2007.42.2.151

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

Sollip Kim, M.D., Chan-Jeong Park, M.D., Kyoo Hyung Lee, M.D.¹, Seongsoo Jang, M.D., Hyun Sook Chi, M.D., Eul-Ju Seo, M.D.

Departments of Laboratory Medicine, Seoul, Korea

¹Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to：Chan-Jeoung Park, M.D. Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea Tel: +82-2-3010-4508, Fax: +82-02-478-0884 E-mail: cjpark@amc.seoul.kr

Received 5 February 2007 Revised 24 April 2007 Accepted 2 May 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Chronic neutrophilic leukemia, Multiple myeloma, Neutrophil function test

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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.

Table 1.

Neutrophil function in the patient with coexisting chronic neutrophilic leukemia and multiple myeloma

Chemotaxis	Neutrophil No./Boyden chamber well (8mm²)
Stimulants	Patient	Normal control		Ratio (Patient/Normal control)
Phosphate buffered saline (random motility)	46,080	16,896		2.73
FMLP∗ 10^?8 M/L	83,968	52,224		1.61
Heat-inactivated normal plasma	73,728	35,840		2.06
Zymosan activated normal plasma	100,352	72,704		1.38
Phagocytosis	Candida albicans	Patient	Normal control	Ratio (Patient/Normal control)
Median channel of fluorescence	178	1,863	440	4.23
Respiratory burst activity	Mean channel of fluorescence (H₂O₂ production)
Stimulants	Patient	Normal control		Ratio (Patient/Normal control)
Rest (no stimulant)	1,106	166		6.66
PMA^† 200ng/mL	7,032	3,020		2.33
Microbial killing			Patient	Normal control
% of C. albicans killing by neutrophils			40.8%	43.1%

∗Formyl-methionyl-leucyl-phenylalanine,

^† Phorbol myristate acetate. Compared with the normal control neutrophils, the patient neutrophils show increased chemotaxis, phagocytosis and respiratory burst activity, especially increased in no stimulation state, but normal microbial killing activity.

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