Coexistence of myelodysplastic syndrome and untreated chronic lymphocytic leukemia with development of acute myeloid leukemia immediately after treatment of chronic lymphocytic leukemia

Abstract

A 72-year-old man originally seen for anemia and thrombocytopenia was determined to have chronic lymphocytic leukemia (CLL). Bone marrow examination at the time of CLL diagnosis revealed a small but significant population of atypical blasts. Cytogenetic analysis of the bone marrow aspirate disclosed chromosomal abnormalities (-7, +8) suggestive of a myelodysplastic syndrome. Shortly after treatment of the CLL, there was proliferation of the previously noted blast population, which cytochemical studies demonstrated to be of the myeloid series thus indicating acute myeloid leukemia superimposed on CLL. This report presents microscopic, cytogenetic, immunophenotypic, and cytochemical evidence to document the evolution of acute myeloid leukemia in the bone marrow of a patient with CLL after one course of chemotherapy.

Acute myeloid leukemia with T‐cell receptor gamma gene rearrangement occurring in a patient with chronic lymphocytic leukemia: A case report

“…Presumed mechanisms for the development of AML in patients with CLL include an immunodeficiency state and/or the use of alkylating agents. When reported, karyotopic abnormalities within the AML blasts are usually consistent with those seen in secondary leukemias [6].…”

“…In the majority of reported cases, acute myeloid leukemia (AML) is diagnosed following treatment of CLL and is thought to be a secondary leukemia or therapy-related AML [5]. However, there are reports of AML arising in patients with previously untreated CLL as well as infrequent cases of AML and CLL diagnosed simultaneously [6]. In most retrospective reviews, the incidence rate of therapy-related AML following CLL treatment is <1% [6].…”

“…However, there are reports of AML arising in patients with previously untreated CLL as well as infrequent cases of AML and CLL diagnosed simultaneously [6]. In most retrospective reviews, the incidence rate of therapy-related AML following CLL treatment is <1% [6]. Presumed mechanisms for the development of AML in patients with CLL include an immunodeficiency state and/or the use of alkylating agents.…”

Treatment-related acute myeloid leukemia in a chronic lymphocytic leukemia patient: role of fludarabine?

“…CLL is also known to be associated with an increased frequency of second hematological malignancies [Hatoum et al 2007]. In majority of cases, this usually involves a disease transformation to an aggressive non-Hodgkin lymphoma, multiple myeloma or prolymphocytic lymphoma [Bracey et al 1989]. CLL patients can rarely develop acute myeloid leukemia (AML) [Bracey et al 1989].…”

Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: Molecular evidence of two separate diseases

“…Rare cases of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) occurring in patients with chronic lymphocytic leukemia (CLL) have been described, with the majority being treatment-related and having unfavorable karyotypes [1][2][3][4][5]. There are approximately 30 cases of AML occurring concurrently with or after untreated CLL in the literature since the 1970s [1,, 17 of which contain immunophenotypic data [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”