Rapid evolving into acute myeloid leukemia in a patient with multiple myeloma and concurrent myelodysplasia after VTD therapy

The association of Myelodysplasia (MDS) and multiple myeloma (MM) has been usually described not only as a complication of chemotherapy but also in the absence of preceding chemotherapy or together at the time of diagnosis. Optimal therapies of a coexisting MM and MDS have not been well established up to now. We report a case of MDS diagnosed simultaneously with MM. After treatment with VTD (bortezomib, thalidomide, dexamethasone) marked anti-myeloma activity was observed, but it was associated with rapid progression of the MDS to acute myeloid leukemia (AML). The leukemic transformation in our case most probably reflects the natural progression of MDS, though it clearly demonstrates that VTD is ineffective in controlling blast proliferation in MDS. To our knowledge, this is the first case report on MDS in the setting of MM with rapid evolution to AML to VTD therapy. More data from more cases are needed, to find the potential utility of VTD therapy in coexisting MDS and MM patients.