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Abstract: FR-PO206

Plasma Cell Leukemia Masquerading as Acute Myeloid Leukemia: An Unusual Clinical Presentation

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Zhang, Xin, Loyola University Health System, Maywood, Illinois, United States
  • Liu, Song, Loyola University Health System, Maywood, Illinois, United States
  • Mirza, Kamran, Loyola University Health System, Maywood, Illinois, United States
  • Picken, Maria M., Loyola University Health System, Maywood, Illinois, United States
  • Bansal, Vinod K., Loyola University Health System, Maywood, Illinois, United States
  • Vellanki, Kavitha, Loyola University Health System, Maywood, Illinois, United States
Introduction

Plasma cell leukemia (PCL) is a rare aggressive variant of plasma cell myeloma. Peripheral blood smear morphology can be misleading in the context of acute leukemia like presentation. We present one such unique experience.

Case Description

A 64 year old female presented with progressive weakness and fatigue. Work-up revealed acute kidney injury (serum creatinine of 6.8 mg/dl) with nephrotic range proteinuria, hypercalcemia, leucocytosis and 12% of circulating cells with blastoid features on peripheral smear (Figure 1). A preliminary diagnosis of acute myeloid leukemia (AML) was given based on circulating cell morphology, flow cytometry and bone marrow (BM) biopsy findings. Work-up for paraproteinemia subsequently revealed significantly elevated serum free lambda light chains. As co-existence of AML and myeloma is extremely unusual, kidney biopsy was done (Figure 2). While there was some phenotypic overlap with myeloid blasts, subsequent immunohistochemistry of BM biopsy with CD138 staining confirmed the diagnosis of PCL. She has since received targeted chemotherapy with recovery of renal function; currently off dialysis with serum creatinine of 2.6 mg/dl.

Discussion

PCL with blastoid morphology is extremely rare and can pose a diagnostic challenge by mimicking acute leukemia. This case illustrates the importance of kidney biopsy in establishing the right diagnosis when clinical features do not correlate with the initial diagnosis.