5q− syndrome and multiple myeloma diagnosed simultaneously and successful treated with lenalidomide

A 72-year-old woman was diagnosed with 5q− myelodysplastic syndrome in the course of an indolent multiple myeloma (MM). Bone marrow (BM) cytogenetics disclosed two unrelated clones: 46,XX,del(5)(q13q33), and [47,X,-X,der(1;21)(q10;q10),−4,−4,+5,del(5)(q13q31),+7,der(7)t(1;7)(p34.2;p22),add(8)(p23),−13,+15,der(16) t(1;16)(q23;q12.2),+19,−21,+mar1,+mar2]. The last complex karyotype belonged to malignant plasma cells. FISH and SKY techniques demonstrated different 5q deletions. EGR1 gene (on 5q31) lost in 5q− syndrome remained in 5q− plasma cells. Biclonal evolution was noted: myeloid 5q− cells added a deletion 13q and plasma cells showed monosomy 13. Patient achieved complete cytogenetic response of 5q− syndrome with low-dose of lenalidomide, and a partial remission of MM with high-dose of lenalidomide/dexamethasone combination.