Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2019; 10(3): 161-165
Published online Mar 24, 2019. doi: 10.5306/wjco.v10.i3.161
Plasma cell leukemia - one in a million: A case report
Akriti G Jain, Mohammed Faisal-Uddin, Abdul K Khan, Mohammed Wazir, Qi Shen, Manoucher Manoucheri
Akriti G Jain, Abdul K Khan, Mohammed Wazir, Manoucher Manoucheri, Internal Medicine, Florida Hospital, Orlando, FL 32804, United States
Mohammed Faisal-Uddin, Deccan College of Medical Sciences, Hyderabad, Telangana 500058, India
Qi Shen, Central Florida Pathology Associates, Florida Hospital, Orlando, FL 32804, United States
Author contributions: Jain AG, Manoucheri M played significant roles in reviewing the manuscript; Faisal-Uddin M, Khan AK, and Wazir M worked on writing the manuscript and Shen Q worked on the pathology legends.
Informed consent statement: We obtained informed consent for publication.
Conflict-of-interest statement: The authors state that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Akriti Gupta Jain, MD, Doctor, Resident, Internal Medicine, Florida Hospital, 2501 N. Orange Avenue, Orlando, FL 32804, United States. akriti.jain@adventhealth.com
Telephone: +1-330-3229730 Fax: +1-407-3032553
Received: November 9, 2018
Peer-review started: November 10, 2018
First decision: December 7, 2018
Revised: January 30, 2019
Accepted: February 27, 2019
Article in press: February 27, 2019
Published online: March 24, 2019
Processing time: 133 Days and 14.3 Hours
Abstract
BACKGROUND

Plasma cell leukemia (PCL) is diagnosed by the presence of an absolute plasma cell count of > 2 × 109/L or 20% plasma cells in the peripheral blood. Because the incidence of PCL is relatively low, our case report study presents a rare opportunity to describe the clinical and pathological characteristics of this leukemia, as well as different modalities of treatment and outcomes of primary PCL (pPCL).

CASE SUMMARY

A 56-year-old male with a history of hypertension complained of pain in the left flank area which started four months prior to admission. On admission, his vital signs were stable, and physical examination was completely benign. Laboratory evaluation showed hemoglobin of 5.1 g/dL, white blood cell count of 6.6 cells per cubic millimeter with 16% atypical lymphocytes, and platelet count of 51000 per microliter. Peripheral smear showed more than 10%-15% of plasma cells (Figure 1), and flow cytometry of peripheral blood confirmed PCL with 24% plasma cells CD138+. Bone marrow biopsy demonstrated 80% plasma cells (38+, 138+, 117+, 10-, 19-, 20-, 56-) with 90% cellularity. The Oncology team was consulted, and VCD therapy was started. After completing therapy at 1, 4, 8, and 11 d, the patient was discharged home. The patient was being considered for a bone marrow transplant evaluation within two months of discharge.

CONCLUSION

PCL is a rare and aggressive form of leukemia with a poor prognosis. Multi-center studies and clinical trials should be conducted to develop accurate criteria for the initial diagnosis and prompt treatment of this disease.

Keywords: Primary plasma cell leukemia; Case report; Rare leukemia; Secondary plasma cell leukemia; Allogenic transplantation; Chemotherapy

Core tip: Always review a peripheral blood film in all cases of multiple myeloma and be aware of an entity called plasma cell leukemia, a rare and aggressive form of leukemia.