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A 53-year-old patient who had a 7 year history of multiple myeloma was diagnosed with high risk myelodysplastic syndrome while on lenalidomide treatment. Progression to acute myeloid leukemia has occurred during the following 4 months. Like our case, secondary primary malignancies (SPMs) can rarely complicate treatment of multiple myeloma. Although possible association between SPMs in patients receiving lenalidomide can be attributed to previous melphalan use, potential SPM risk with lenalidomide cannot still be ruled out safely
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