Simultaneous occurrence of myelomonocytic leukemia and multiple myeloma: Involvement of common leukemic progenitors and their developmental abnormality of “lineage infidelity”

We investigated the origin of leukemic progenitors in a case of the simultaneous occurrence of myelomonocytic leukemia and multiple myeloma (IgG‐K). At presentation, myeloperoxidase and nonspecific esterase‐positive myelomono‐cytic cells had proliferated up to 12.2 x 10⁹/liter in the peripheral blood. Bone marrow cell differentials revealed the coexistence of myelomonocytic cells (30%) and atypical plasmacytoid cells (26%). Myelomonocytic cells in peripheral blood expressed both myeloid antigens (CD11b, CD13, CD14, CD15, CD33) and T/B‐lymphoid antigens (CD2, CD4, CD5, CD7, CD10, PCA‐1). Bone marrow mononuclear cells (BMMC) could be divided into PCA‐1 strongly positive and PCA‐1 weakly positive populations, which were considered to represent myeloma cells and myelomonocytic cells, respectively; the former were CD2‐positive (CD2⁺), CD14⁻, and CD15⁻, whereas the latter were CD2⁺, CD14⁺, and CD15⁺. Immunohistochemical analysis revealed that, in addition to plasmacy‐toid cells, a minority of myelomonocytic cells showed a positive reaction for IgG staining, and production of IgG was observed in the culture supernatant of CD14⁺ myelomonocytic cells in peripheral blood. Southern blot analysis revealed the presence of two identical rearrangement bands of immunoglobulin heavy chain gene in both BMMC containing myeloma cells and myelomonocytic cells and CD14⁺ myelomonocytic cells in peripheral blood. In a long‐term methylcellulose assay, peripheral blood mononuclear cells produced large compact colonies consisting of macrophages and IgG⁺ plasmacytoid cells (Mϕ/P colonies), while BMMC produced a different type of colonies consisting of CD14⁺ myelomono‐blasts, macrophages, and IgG⁺ plasma cells (Mb/Mϕ/P colonies) in addition to Mϕ/P colonies. Recloning experiments showed that primary Mb/Mϕ/P colonies gave rise to both secondary Mϕ/P and Mb/Mϕ/P colonies. These observations strongly suggest that common leukemic progenitors provide both myeloma and myelomonocytic leukemia cells, and the mechanism of “lineage infidelity” is probably involved in the development of their “bilineal” differentiation.