Concomitant chronic lymphocytic leukemia and acute myeloid leukemia: Evidence of simultaneous expansion of two independent clones

Abstract

The simultaneous appearance of chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) has been rarely reported, with AML occurring more frequently as a secondary event in patients receiving cytotoxic drugs for a primary lymphoproliferative disorder. We describe a case of simultaneous CLL and AML documented by morphological and cytometric analysis in a previously untreated patient. In particular, on the basis of morphological and immunological features, the patient was diagnosed as being affected by CD34 + /CD13 + /CD33 + /HLA-DR + /CD7 + FAB-M2 AML, along with a B-CLL characterized by neoplastic cells expressing a VH3-53/D3-22/JH4 Ig, bearing, on average, 3.9% IgVH mutations without evidence of antigen-driven selection. To establish whether the two neoplastic cell populations shared some common molecular signature, we performed IgH gene rearrangement studies on CD34 + /CD19- and CD34-/CD19 + immunomagnetically sorted cell populations: only genomic DNA from the CD19 + /CD34- cell fraction revealed the presence of the IgH gene rearrangement. These results provide evidence that the rare concomitant association of CLL and AML likely arises from simultaneous expansion of two independent clones.

Next-generation sequencing and FISH studies reveal the appearance of gene mutations and chromosomal abnormalities in hematopoietic progenitors in chronic lymphocytic leukemia

“…By contrast, IGH alterations were not present in any of the CD34+ hematopoietic progenitors. Previous case report studies have yielded similar results [34, 35], suggesting that IGH alterations occur in an advanced stage of the lymphocyte maturation process.…”

A Case of Acute Myeloid Leukemia Concurrent With Untreated Chronic Lymphocytic Leukemia

“…Regarding primary etiology, impaired immunity and old age have been discussed previously [6]; our patient had both these risk factors. Graf [7] suggested that, due to the plasticity of neoplastic common progenitor cells, the neoplastic transformation of common progenitor cells could occur during hematopoietic differentiation, and they could develop into two separate lineages (myeloid and lymphoid).…”

Intravascular lymphomatosis of the brain in a patient with myelodysplastic syndrome

“…13,14 However, most types of non-Hodgkin lymphoma that have previously been associated with a diagnosis of MDS were slowly progressive forms of chronic lymphocytic leukemia (Cll), in which the development of MDS (and in some instances even AMl) followed chemotherapy with leukemo genic alkylating agents-and might, thus, have been therapyrelated 7 -or a long period of presumed immunosuppression from disease-related lymphocytopenia. 14,15 Much debate has taken place concerning the nature of this concomitant occurrence of MDS and Cll and, although the involvement of common leukemo genic or stem-cell mechanisms could not always be excluded, several cases have been demonstrated to result from neoplastic clones within different cell lineages. 14,15 In the patient discussed here, MDS-or at least an uncommonly long preceding 4-year period of macrocytic anemia and, eventually, pancytopenia-marked a disease process that eventually culminated in a rapidly progressive syndrome of Ivl.…”

“…14,15 Much debate has taken place concerning the nature of this concomitant occurrence of MDS and Cll and, although the involvement of common leukemo genic or stem-cell mechanisms could not always be excluded, several cases have been demonstrated to result from neoplastic clones within different cell lineages. 14,15 In the patient discussed here, MDS-or at least an uncommonly long preceding 4-year period of macrocytic anemia and, eventually, pancytopenia-marked a disease process that eventually culminated in a rapidly progressive syndrome of Ivl. Despite a relative paucity of literature on this topic, several other cases have been reported in which Ivl followed a previous diagnosis of MDS.…”