An unusual association of monoclonal gammopathy, paroxysmal nocturnal haemoglobinuria and myelodysplastic syndrome transformed into acute myeloid leukaemia: Coexistence of triple clonal disorders

An unusual association of paroxysmal nocturnal haemoglobinuria (PNH), myelo dysplastic syndrome (MDS), acute myeloid leukaemia (AML) and monoclonal gam mopathy is reported. A 60-year old male, who had a history of IgA monoclona l gammopathy, presented with haemoglobinuria and colic pain. Flow cytometry showed CD55(negative)/59(dim) peripheral red cells, and bone marrow examin ation disclosed MDS. Eleven months, he developed later AML with disappearan ce of the PNH clones, although the monoclonal gammopathy persisted. The rel ationship between PNH and MDS has not fully been assessed, although our fin dings indicate that these triple clonal disorders, all coexisted in one pat ient.