Transformation of Multiple Myeloma to High-Grade Lymphoma

Multiple myeloma can rarely transform to large-cell lymphoma. This may represent dedifferentiation of the original plasma cell tumor or the emergence of a different clone.

Patients present with rapidly enlarging soft tissue masses and/or marrow involvement. This transformation has a poor prognosis with a median survival of 4 months. It has been suggested that these patients may be more effectively treated with regimens for non-Hodgkin lymphoma than standard myeloma regimens.

The imaging appearance can be mimicked by the more common extraosseous myeloma. Indeed, lymph nodes are common sites of extraosseous involvement, with gross involvement of the lymph nodes seen in 5% of patients with extraosseous myeloma on autopsy.

References

• Mintzer D, Bagg A. Clinical syndromes of transformation in clonal hematologic disorders. Am J Med. 2001 Oct 15;111(6):480-8.
• Moulopoulos LA, Granfield CA, Dimopoulos MA, Kim EE, Alexanian R, Libshitz HI. Extraosseous multiple myeloma: imaging features. AJR Am J Roentgenol. 1993 Nov;161(5):1083-7.
• Suchman AL, Coleman M, Mouradian JA, Wolf DJ, Saletan S. Aggressive plasma cell myeloma. A terminal phase. Arch Intern Med. 1981 Sep;141(10):1315-20.
• Wahlin A, Roos G, Hörnsten P. Multiple myeloma--transformation to high-grade malignant lymphoma. Acta Oncol. 1988;27(4):411-3.