Hodgkin lymphoma in a case of chronic myeloid leukemia treated with tyrosine kinase inhibitors

Abstract

Chronic myeloid leukemia (CML) is characterized by increased and unregulated proliferation of granulocytic lineage in the bone marrow and presence of these immature myeloid cells in the peripheral blood with presence of Philadelphia (Ph) chromosome. Tyrosine kinase inhibitors are the most important drugs in the CML therapy and provide long disease-free survival. Due to the increased survival of CML patients with continual administration of these drugs, the chance of development of secondary malignancies may increase. The most common secondary malignancies are prostate, colorectal and lung cancer, non-Hodgkin lymphoma, malignant melanoma, non-melanoma skin tumors and breast cancer. Herein, we are describing a rare case of Hodgkin lymphoma in a patient of CML after ten year of primary disease presentation. Hodgkin lymphoma in a known case of CML is very rare and further studies are also needed to know the pathogenic relationship between the two entities and to assess the risk of secondary Hodgkin lymphoma in CML patients treated with tyrosine kinase inhibitors. CML itself is a risk factor for development of solid cancers and hematologic malignancies. In addition, patients on chemotherapy are immune-compromised and may be at greater risk of neoplasm driven by infectious agents such as Epstein-Barr virus.

High‐grade B‐cell lymphoma developed during the treatment of chronic myeloid leukemia with bosutinib

“…Table 1 showed the detailed clinical course of lymphomas that developed during TKI treatment in CML patients. [10][11][12][13][14][15][16][17] Among them, imatinib was the most commonly used medication, while there were no reports of patients who were treated with bosutinib. The time from the initial TKI dose to the onset of the secondary cancer was longest in our case.…”

Precursor Lymphoblastic Lymphoma in the Extramedullary Tissue: A Rare Manifestation of Chronic Myeloid Leukemia in Blast Crisis

“…On review of literature, it is studied that CML is one of the risk factors for the occurrence of other cancers (solid and hematological) secondary to bcr-abl aberrations [8]. Bcr-abl gene arises due to the translocation of the gene between long arm of chromosome 9 to chromosome 22.…”

“…This leads to the Philadelphia chromosome (the hallmark of CML). Gajendra et al suggested that this bcr-abl aberration has the potential to give rise to other malignancies due to genetic instability and clonal evolution [8]. Yap et al proposed the concept of tumor heterogeneity and sub-clonal evolution and compared this tumor heterogeneity with the growing tree model [9].…”

High grade B-cell lymphoma developed in the course of chronic myeloid leukemia treatment with bosutinib

“…Sasaki K et al reported 31 (0.2%) CML patients with secondary lymphoma, but their clinical courses are unknown. Table 1 showed the detailed clinical course of lymphomas that developed during TKI treatment in CML patients [10][11][12][13][14][15][16][17] . Among them, imatinib was the most commonly used medication, while there were no reports of patients who were treated with bosutinib.…”