Multiple myeloma in a patient with prior splenic lymphoma

Abstract

Splenic marginal zone lymphoma is a mature B-cell neoplasm, as multiple myeloma; however, the coexistence of these two entities in the same patient is rare. We present the case of an 82-year-old older adult male with a history of prostatic hyperplasia and arterial hypertension, who at the time of consultation presented general syndrome, fever, abdominal discomfort, hypocolored mucous membranes and palpable spleen tip, without peripheral lymphadenopathy. After performing the paraclinical examinations and according to the result of the spleen biopsy, a splenic marginal zone lymphoma was diagnosed, with no clinical or laboratory evidence of multiple myeloma or Waldestrom's disease. Splenectomy was performed. Subsequently, the patient received six cycles of chemotherapy. He evolved favorably, the symptoms disappeared, the altered complementary symptoms returned to normal and it was decided to continue consultations according to protocol. After four years, in a follow-up consultation, he reported severe bone pain, especially at the level of spine and hips, as well as weight and appetite loss. A second hematologic malignancy, a stage IIIb multiple myeloma, was diagnosed. Treatment with a scheme of the elderly was carried out, based on the careful use of steroids, melphalan and bisphosphonates. Despite the delicate nature of the case, the patient had a 26-month survival after the second diagnosis.