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January 10, 1977

Secondary Neoplasms in Multiple Myeloma

JAMA. 1977;237(2):120. doi:10.1001/jama.1977.03270290020015

To the Editor.—  The coexistence of multiple myeloma and another cancer in the same patient has been reported on several occasions.1The occurrence of second neoplasms in patients treated with melphalan for multiple myeloma (236:1609, 1976) is a rare but well-recognized phenomenon. The most frequent second neoplasm is acute myelocytic leukemia.2 It is far from clear whether the melphalan is causally related to the development of acute leukemia or whether this disease represents the natural evolution of multiple myeloma hitherto obscured by early deaths.I agree with the editorial (236:1612, 1976) that such reports... should alert physicians and stimulate a careful examination of all patients who receive melphalan to determine if multiple primary neoplasia is occurring in these patients and to assess its suppressive effect on tumor growth in those patients who do not have multiple myeloma or some other condition that may impair immunocompetence.There could develop