Annals of Hematology

, Volume 98, Issue 10, pp 2431–2432 | Cite as

How to resolve a clinical and molecular puzzle: concomitant monoclonal gammopathy of undetermined significance (MGUS) with neutrophilia and clonal hematopoiesis of indeterminate potential (CHIP)

  • Simon Haefliger
  • Darius Juskevicius
  • Sylvia Höller
  • Ulrich Buser
  • Stefan Dirnhofer
  • Alexandar TzankovEmail author
Letter to the Editor

Dear Editor,

The association between plasma cell (PC) neoplasms (PCN) and neutrophilia is a rare but well-known phenomenon [1, 2, 3]. CHIP designates asymptomatic presence of clones in the peripheral blood and/or the bone marrow carrying somatic mutations of genes, typically mutated in myeloid neoplasms, with a not exactly predictable risk of progression towards cancer, bearing analogies to MGUS and monoclonal B-lymphocytosis [4, 5]. We report on a patient with concomitant MGUS, neutrophilia, and CHIP, rising questions of the nature of neutrophilia in PCN as well as caveats of overinterpretation due to the simultaneous co-existence of MGUS and CHIP.

A 60-year-old Caucasian male presented with fatigue and splenomegaly in 2008. Blood counts showed leukocytosis with mature neutrophilia [leukocytes of 32 g/L (reference, 4-12 G/L) with 90% neutrophils (28.8 G/L)]. Immunofixation electrophoresis revealed IgG κmonoclonal gammopathy (13.1 g/L (reference, 0.7–1.6 g/L)) without CRAB criteria....


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of informed consent

Written informed consent was obtained from the patient.


  1. 1.
    Stevens B, Maxson J, Tyner J et al (2015) Clonality of neutrophilia associated with plasma cell neoplasms: report of a SETBP1 mutation and analysis of a single institution series. Leuk Lymphoma 57:927–934CrossRefGoogle Scholar
  2. 2.
    Swerdlow SH, Campo E, Harris NL et al (2017) WHO classification of tumours of haematopoietic and lymphoid tissues, revised, fourth edn. IARC Press, LyonGoogle Scholar
  3. 3.
    Blombery P, Kothari J, Yong K, Allen C, Gale RE, Khwaja A (2014) Plasma cell neoplasm associated chronic neutrophilic leukemia with membrane proximal and truncating CSF3R mutations. Leuk Lymphoma 55:1661–1662CrossRefGoogle Scholar
  4. 4.
    Steensma DP, Bejar R, Jaiswai S et al (2015) Clonal hematopoiesis of indeterminate potential and its distinction from myelodysplastic syndromes. Blood 126:9–16CrossRefGoogle Scholar
  5. 5.
    Strati P, Shanafelt TD (2015) Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification. Blood 126:454–462CrossRefGoogle Scholar
  6. 6.
    Sato H, Wheat JC, Steidl U et al (2016) DNMT3A and TET2 in the pre-leukemic phase of hematopoietic disorders. Front Oncol 6:187CrossRefGoogle Scholar
  7. 7.
    Nedeljkovic M, He S, Szer J, Juneja S (2014) Chronic neutrophilia associated with myeloma: is it clonal? Leuk Lymphoma 55:439–440CrossRefGoogle Scholar
  8. 8.
    Kusaba N, Yoshida H, Ohkubo F et al (2004) Granulocyte-colony stimulating factor-producing myeloma with clinical manifestations mimicking chronic neutrophilic leukemia. Rinsho Ketsueki 45:228–232Google Scholar
  9. 9.
    Kohmura K, Miyakawa Y, Kameyama K, Kizaki M, Ikeda Y (2004) Granulocyte colony stimulating factor-producing multiple myeloma associated with neutrophilia. Leuk Lymphoma 45:1475–1479CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of PathologyUniversity of Basel, University Hospital BaselBaselSwitzerland

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