Secondary Myelodysplasia Induced by Unproven Use of Melphalan

Background: Authors report on a patient with monoclonal gammopathy who was misdiagnosed as multiple myeloma and treated with alkylating agent, melphalan. The patient developed myelodysplasia and eventually died of disease complications. The coexistence of myelodysplasia and monoclonal gammopathy and/or multiple myeloma is well known from the literature. The chemotherapy induced secondary myelodysplasia provides a much poorer outcome than that in the two conditions apart from each other. Methods: Authors also present a FISH method successfully applied on plastic embedded archive bone marrow samples for the detection of chromosome alterations. Conclusions: Authors emphasize the importance to follow guidelines when giving chemotherapy, especially melphalan, which is a known inducer of secondary myelodysplasia and leukemia. The FISH method for the detection of chromosome abnormalities described here on archive acrylate embedded bone marrow samples might update earlier findings that have been thought to be lost for scientific workup.