Concomitant presentation of two chronic leukemias: Evidence for independent clonal evolution

Abstract

A case of chronic lymphocytic leukemia (CLL) occurring simultaneously with Philadelphia chromosome-positive chronic granulocytic leukemia (CGL) in a 58-year-old man is described. The patient presented with typical CGL (all bone marrow mitoses having a Philadelphia chromosome), but during the course of busulfan therapy, CLL became more prominent, less than half of the bone marrow mitoses having a Philadelphia chromosome. The patient is in good clinical condition after a follow-up of 3.5 years, and the clinical picture resembles that of typical CLL.The coexistence of CGL and CLL here may be explained by chance alone. Evidently the histogenesis of t w o chronic leukemias in our patient took place as an independent evolution of two malignant hematopoietic clones. In spite of the frequent association of chronic leukemias with secondary cancer, no well-documented cases of two chronic leukemias with a simultaneous presentation have been described previously.

The coexistence of chronic lymphocytic leukemia and myeloproliperative neoplasms: A retrospective multicentric GIMEMA experience

“…To our knowledge, the series described in the present retrospective multicentre study is the largest so far reported in the literature: a total of 46 patients affected by CLL/MBL and concomitant MPN, followed by 15 Italian GIMEMA centers were analyzed in this study. In comparison with data emerging from the cases reported in the literature, we observed a lower incidence of CML (19.5% vs. 46.6%) [7–30] and PV (21.7% vs. 32%) [34, 35, 40–53], and a higher incidence of ET (39.2% vs. 21.4%) [31–39] and PMF (13% vs. 1.7%) [54]. In addition, we detected for the first time 3 cases (6.6%) of CLL associated with atypical CML (MPN/MDS).…”

“…This distribution is similar to what has been reported in the literature, where in roughly one third of cases the diagnosis of MPN was established before, concomitantly or after the diagnosis of CLL (39.4%, 30.3%, and 30.3%, respectively). Most diagnoses of CML both in our series and in the literature followed the diagnosis of CLL (77.7% and 52%, respectively) [18–29], although in our experience none of them occurred simultaneously, in contrast to the 28% of concomitant cases reported in the literature [11–17].…”

“…The spectrum of secondary solid neoplasms during the course of CLL includes carcinomas of the skin, stomach, colon, breast, or kidney [4, 5]; among secondary hematologic malignancies, cases of acute lymphocytic, myelocytic, monocytic and myelomonocytic leukemia, erythroleukemia, plasma cell leukaemia [6], and myeloproliferative neoplasms (MPN) have been reported [7–54].…”

“…In fact, most of the reported cases are purely anecdotal and merely descriptive. In a review of the literature, we found 25 cases of CLL/chronic myeloid leukemia (CML) [7–30], 18 cases of CLL/polycythemia vera (PV) [34, 35, 40–53], 12 cases of CLL/essential thrombocythemia (ET) [31–39], and only one case of CLL with primary myelofibrosis (PMF) [54].…”

“…The pattern of onset of the two neoplastic disorders is extremely heterogeneous and appears to depend on the type of concomitant MPN. Among the 25 CLL/CML cases reported in the literature [7–30], in most (52%) the diagnosis of MPN followed the diagnosis of CLL [18–29], in 7 (28%) the two diseases were diagnosed concomitantly [11–17] and in 5 (20%) the diagnosis of CML preceded that of CLL [7–10, 30]. In contrast, in none of 12 CLL/ET cases the diagnosis of ET followed the diagnosis of CLL [31–39].…”