Simultaneous chronic lymphocytic leukemia and chronic myelogenous leukemia. Evidence of a separate stem cell origin

Abstract

The authors studied a patient with the simultaneous occurrence of chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML). The coexistence of these two hematologic malignancies leads to questions about their cell of origin. Through analysis of this patient's DNA, the authors studied the derivation of the two malignancies. They separated the blood into a myeloidrich fraction and a fraction containing the malignant lymphocytes. JH and bcr probes were used to study these loci in the myeloid and lymphoid fractions and in unfractionated white blood cells. The authors found that the unfractionated leukocytes contained the bcr and JH rearrangements. Conversely, the lymphoid fraction contained only the JH rearrangement, and the myeloid fraction contained only the bcr rearrangement, suggesting that these malignancies arose from separate stem cells. This is the first reported patient with simultaneously occurring CML and CLL definitively shown to arise from distinct progenitors, and this report raises questions about the origin of these two cell lines.

Increased incidence of monoclonal B-cell infiltrate in chronic myeloproliferative disorders

“…Sporadic cases have been described where patients presented simultaneously or consecutively CMPD, mainly chronic myeloid leukemia (CML), and multiple myeloma (MM), chronic lymphocytic leukemia (CLL) or hairy cell leukemia (HCL). [1][2][3][4][5] Systematic analysis of the incidence of coexisting malignant lymphoma (ML) with CMPD in untreated patients is not available in the literature to our knowledge. The diagnosis of a coexisting indolent lymphoma-except multiple myeloma, where light-chain restriction analysis by immunohistochemistry is available-is not easy by histology of the trephine biopsy sample alone, because various amoun of lymphocytic infiltrate is a well-known feature of the different CMPDs.…”

Chronic Myeloid Leukemia as a Secondary Malignancy Following Treatment of Diffuse Large B-Cell Lymphoma

“…Until now, CML has been reported after treatment for Hodgkin disease (HD), hairy cell leukemia, or chronic lymphocytic leukemia (CLL). It is not clear whether development of CML as a secondary malignancy represents a therapy-induced complication or possibly a genetic susceptibility to malignancy in which the host may be able to bear 2 different clonal malignanT-cells [3,4]. There is also a possibility that the 2 malignant clones derive from a common malignant stem cell [4].…”

Simultaneous manifestation of chronic lymphocytic leukemia (CLL) and hairy cell leukemia (HCL)

“…Both diseases are associated with an increased frequency of simultaneous or coexistent second malignancies, including different types of lymphoproliferative disorders [2][3][4][5][6]. A recent report suggested increased frequency of the association between CLL and HCL [7].…”