Paraproteinemia in a Patient with Acute Myelogenous Leukemia Derived from the Myelodysplastic Syndrome : A Case Report

Severe paraproteinemia was found in a 75-year-old female with acute myelogenous leukemia (AML) derived from refractory anemia with an excess of blasts, a type of the myelodysplastic syndrome (MDS). Immunoglobulin G-κ and G-λ paraproteins had increased in accordance with the proliferation of myeloblasts in her bone marrow. When the diagnosis of AML was made, a severe bleeding tendency and disturbance of consciousness due to the hyperviscosity syndrome were noted, although there was no significant increase in plasma cells in her bone marrow. An ultrasonogram disclosed multiple hyperechoic nodular lesions in the spleen. Cytoreductive therapy for AML was begun after plasma exchange, but she died of acute renal failure, subarachnoid hemorrhage, and the disseminated intravascular coagulation syndrome. Autopsy findings revealed clusters of plasma cells in the spleen and lymph nodes. The possibility that this coexistant paraproteinemia and AML were related to the evolution of a transformed clone in MDS is discussed