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Detailed Match Coverage: Day-by-Day Analysis
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Betting Tips & Strategy Insights
Betting enthusiasts can benefit greatly from our tailored tips designed specifically around each day's fixtures. By analyzing player form trends along with surface preferences or head-to-head records against opponents scheduled later today or tomorrow—our recommendations aim at optimizing potential returns while minimizing risks involved in sports wagering associated with these dynamic events at Tennis M15 Allershausen Germany tournaments specifically designed around men aged 16-18 years competing across various singles categories throughout Europe including prestigious events hosted annually since inception back 2005/06 seasons onwards...
1: DOI: 10.1097/MD.0000000000033710
2: # A rare case report: Combined acute promyelocytic leukemia (APL) with multiple myeloma (MM): A case report
3: Authors: Yan Liang Wang Jie Zhang Liang Jie Huang Liang Yang Hui Wang Liang Chen Hua Zhou Shu Zhao Fei Guo Hai Bo Zheng Si Ma Xiao Yu Pan Hong Jiang Si Yuan Liu Jian Yang Qi Xian Guo Si Chao Yang Xu Meng Xiao Xin Jin Ying Wen Chun Yu Jing Cao Sheng Ye Zhu Qing Hu Wang Bing Li Feng Min Yang Jing Wen Liu Jing Nan Chen Guo Qiang Bi Ming Zong Hua Yin Yue Zhao Xue Peng Chen Jia You Yun Zhang Ji Lin Jin Yang Feng Ting Dong Hua Chang Jin Jian Fang Ping Xu Zhi Guo Xian Zhi Xie Xiao Jie Zhou Yi Li Qin Xiang Wei Zhao Jun He Tian Fang Cai Lin Na Xi Li Yi Lu Wang Jian Ning Sun Xue Feng Liu Shu Lin Zhong Fang Qiu Ling Han Jian Wei Lei Bao Zheng Wei Bao Qing Yu Shen Shi Hua
4: Journal: Medicine
5: Date: 21 April 2023
6: Keywords: acute promyelocytic leukemia (APL), combined acute promyelocytic leukemia (APL) with multiple myeloma (MM), multiple myeloma (MM), rare disease
7: ## Abstract
8: **Rationale:**Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by specific chromosomal translocation t(15;17)(q24;q21) resulting in PML-RARα fusion gene expression. Multiple myeloma (MM) is a hematological malignancy characterized by abnormal proliferation of plasma cells within bone marrow microenvironment accompanied by monoclonal immunoglobulin production.
9: **Patient concerns:**A 66-year-old female was admitted due to recurrent fever accompanied by coughing phlegm.
10: **Diagnoses:**The patient was diagnosed as combined APL with MM based on clinical manifestations such as fever; physical examination findings such as generalized lymphadenopathy; laboratory tests such as peripheral blood smear showing leukocytosis; bone marrow cytology showing hyperplasia of granulocytic precursors; immunohistochemistry showing positive expression of CD117/CD34/MPO; flow cytometry showing positive expression of CD117/CD34/MPO; bone marrow cytology showing plasmacytosis; immunohistochemistry showing positive expression of CD38/CD138/Kappa light chain; flow cytometry showing positive expression of CD38/CD138/Kappa light chain; serum protein electrophoresis showing monoclonal protein band; urine protein electrophoresis showing Bence Jones protein.
11: **Interventions:**The patient was treated with ATRA + ATO + chemotherapy.
12: **Outcomes:**The patient achieved complete remission after treatment.
13: **Lessons:**This case report enriches clinical understanding of APL combined with MM by reporting a rare case combining APL with MM which has not been reported before.
14: ## 1. Introduction
15: Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by specific chromosomal translocation t(15;17)(q24;q21) resulting in PML-RARα fusion gene expression. Multiple myeloma (MM) is a hematological malignancy characterized by abnormal proliferation of plasma cells within bone marrow microenvironment accompanied by monoclonal immunoglobulin production.
16: In this study we report a rare case combining APL with MM which has not been reported before.
17: ## 2. Case presentation
18: ### 2.1. Chief complaints
19: A 66-year-old female was admitted due to recurrent fever accompanied by coughing phlegm.
20: ### 2.2. History of present illness
21: The patient had been hospitalized in another hospital due to fever over 1 month ago without obvious cause after being examined by routine blood test which showed white blood cell count (WBC) was 22 × 10^9 /L while platelet count was 50 × 10^9 /L so she was given piperacillin sodium/tazobactam sodium injection intravenously after admission but her fever did not improve so she took cefoperazone/sulbactam sodium injection intravenously but still no response so she took ceftazidime sodium injection intravenously but her condition did not improve so she took moxifloxacin hydrochloride injection intravenously but her condition did not improve so she was transferred into this hospital.
22: ### 2.3. History of past illness
23: The patient had no history of hypertension or diabetes mellitus.
24: ### 2.4. Personal and family history
25: The patient had no personal or family history.
26: ### 2.5. Physical examination
27: Physical examination showed body temperature was 37°C while pulse rate was 77 times/min while respiration rate was 18 times/min while blood pressure was 132/87 mm Hg while oxygen saturation was 98% while weight was 52 kg while height was 155 cm while BMI was 21.6 kg/m^2 while consciousness level was clear while skin had no jaundice or cyanosis while head face had no obvious deformity or swelling while eyes had conjunctival congestion while nose had nasal congestion while throat had no exudation while trachea was midline without deviation while lungs had moist rales at both lung bases without wheezing rales heard over heart had regular rhythm without murmur over abdomen had no tenderness or rebound tenderness over superficial lymph nodes were not enlarged over limbs had no swelling or deformity over neurologic system had no meningeal irritation signs.
28: ### 2.6. Laboratory examinations
29: Peripheral blood routine examination showed WBC count was 43 × 10^9 /L (neutrophil count was 30 × 10^9 /L; lymphocyte count was 6 × 10^9 /L; monocyte count was 6 × 10^9 /L; eosinophil count was less than1 ×10^9 /L; basophil count was less than1 ×10^9 /L); red blood cell count was 2.88 × 10^{12} /L; hemoglobin level was 73 g/L; platelet count was less than50 ×10^9 /L (Table 1). Bone marrow cytology showed hyperplasia of granulocytic precursors (Figures 1–5). Immunohistochemistry showed positive expression of CD117/CD34/MPO(Figures 6–8). Flow cytometry showed positive expression of CD117/CD34/MPO(Figures 9–11). Serum protein electrophoresis showed monoclonal protein band(Figure 12). Bone marrow cytology showed plasmacytosis(Figures 13–14). Immunohistochemistry showed positive expression of CD38/CD138/Kappa light chain(Figures 15–17). Flow cytometry showed positive expression of CD38/CD138/Kappa light chain(Figures 18–20). Urine protein electrophoresis showed Bence Jones protein(Figure 21).
30: **Table 1:** Peripheral blood routine examination results.
31: | Item | Reference range | Patient’s results |
32: | --- | --- | --- |
33: | White blood cell count | (4–10) ×10^9 /L | >43 |
34: | Neutrophil count | (1.8–6.3) ×10^9 /L | >30 |
35: | Lymphocyte count | (1–3) ×10^9 /L | >6 |
36: | Monocyte count | (0–0.8) ×10^9 /L | >6 |
37: | Eosinophil count | (0–0.5) ×10^9 /L | ≦1 |
38: | Basophil count | (0–0.1) ×10^9 /L | ≦1 |
39: | Red blood cell count | (4–5) ×10^{12} /L | >2.88 |
40: | Hemoglobin level | (120–160) g/L | >73 |
41: | Platelet count | (100–300) ×10^9 /L | ≦50 |
42: **Figure 1.:** Bone marrow cytology slide showing hyperplasia of granulocytic precursors under low magnification.(H&E stain).
43: [image:medi-102-e33710-g001]
44: **Figure 2.:** Bone marrow cytology slide showing hyperplasia of granulocytic precursors under high magnification.(H&E stain).
45: [image:medi-102-e33710-g002]
46: **Figure 3.:** Bone marrow cytology slide showing hyperplasia of granulocytic precursors under high magnification.(May-Grunwald-Giemsa stain).
47: [image:medi-102-e33710-g003]
48: **Figure 4.:** Bone marrow cytology slide showing hyperplasia of granulocytic precursors under high magnification.(May-Grunwald-Giemsa stain).
49: [image:medi-102-e33710-g004]
50: **Figure 5.:** Bone marrow cytology slide showing