Translate page

× To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below).

Each clinical case will be forwarded to the expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity. To help us get you the most relevant response and advice we ask for your email address. This will not be posted on the website, but is useful should further details be requested by the moderator. Please also include the country where the case is being treated.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are ONLY ACCEPTED FROM CLINICIANS. If individual patients have a specific question we encourage them to contact their healthcare provider. General questions can be emailed to

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guarantee as to the same. Reliance on any information provided in this Forum is solely at your own risk.

A case of neutrophilic leucocytosis and concurrent Monoclonal gammopathy

5 months 2 weeks ago #1894 by
70 year old male, having neutrophilic leucocytosis, ANC approx 20-25000/cmm along with hepatosplenomegaly for last 4 years. Bone marrow done at a different centre doesn’t show any blast, Neutrohilic abundance in BM. BCR-ABL negative , JAK V617F negative.

To find out causes of neutrophilia led us to SPEP- M Spike 3.2 gram/dl. IgA 3700mg/dl, IgM and IgG very low. The patient is also having hyperuricemia, mild KFT derangement.

Am I dealing with Plasma Cell disorder with secondary neutrophilic leucocytosis or two different entities separately?

How to proceed?
  • David Ross
  • David Ross's Avatar
4 months 3 weeks ago - 4 months 3 weeks ago #1895 by David Ross
It is well-recognised that neutrophilia can occur in plasma cell disorders, presumably due to abnormal cytokine production. Did the BM confirm a clonal plasma cell disorder? In MGUS or myeloma it is unusual to have hepatosplenomegaly, so I can understand the clinician’s concern.

Chronic neutrophilic leukaemia is most commonly associated with mutations in CSF3R, so additional molecular testing (myeloid NGS panel) would be useful to determine whether this is one disease or two. If the clinician does not have access to more detailed molecular testing, then it may be reasonable simply to see whether the neutrophilia goes away when the plasma cell disorder is treated (assuming that there is an indication for treatment).
Last edit: 4 months 3 weeks ago by arlene.
Moderators: Melissa Davis-Bishop