What question did this study set out to answer?

To discuss a rare coexistence of chronic myelomonocytic leukemia and plasma cell myeloma in an elderly patient, emphasizing diagnostic and therapeutic complexities.

January 22, 2026Open Access

Concomitant plasma cell myeloma and chronic myelomonocytic leukemia in elderly: diagnostic complexity, therapeutic challenges – case report and literature review

Key Points

To discuss a rare coexistence of chronic myelomonocytic leukemia and plasma cell myeloma in an elderly patient, emphasizing diagnostic and therapeutic complexities.
Reported the clinical presentation and laboratory findings of an elderly female patient
Performed imaging studies and a bone marrow biopsy for diagnosis
Utilized next-generation sequencing to identify NRAS and TET2 mutations
Administered leukapheresis and cytoreduction therapies
Confirmed dual pathology of CMML and plasma cell myeloma through integrated analysis
Identified mutations supporting CMML diagnosis
Treatment complicated by cytopenias requiring transfusions
Patient stabilized and discharged to a nursing facility

Abstract

Introduction and importance: Chronic Myelomonocytic Leukemia (CMML) is a rare clonal hematopoietic disorder with overlapping features of myelodysplastic syndromes and myeloproliferative neoplasms. Its diagnosis becomes more challenging when coexisting with other hematologic malignancies. We report a rare dual pathology of CMML and plasma cell myeloma in an elderly female, highlighting the complexity of diagnosis and management. Case presentation: An 82-year-old female, previously treated for cervical cancer, presented with bilateral buttock pain, gait disturbance, and weakness. Laboratory findings revealed marked leukocytosis (WBC 85 × 10 3 /μl), monocytosis (30.1%), anemia, thrombocytopenia, hypercalcemia, and renal dysfunction. Imaging showed sclerotic bone lesions and bilateral hydronephrosis. Bone marrow biopsy revealed 20–25% CD138 + plasma cells alongside features of CMML, including myeloid hyperplasia and atypical megakaryocytes. Next-generation sequencing detected NRAS and TET2 mutations. She underwent leukapheresis, hydroxyurea for cytoreduction, and bortezomib-dexamethasone for myeloma. Her course was complicated by cytopenias requiring transfusions. She was discharged to a skilled nursing facility upon stabilization. Clinical discussion: This case illustrates the diagnostic complexity of overlapping hematologic malignancies. The coexistence of CMML and myeloma, although rare, was confirmed through integrated morphologic, immunophenotypic, and molecular analysis. The presence of NRAS and TET2 mutations supported CMML. Treatment required balancing cytoreduction with supportive care, especially given her renal dysfunction and marrow suppression. Conclusion: Dual hematologic malignancies demand a multidisciplinary approach. In elderly patients with cytopenias and monocytosis, thorough diagnostic workup is crucial. This case emphasizes the need for personalized therapy in complex hematologic overlap syndromes.

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