Simultaneous existence of acute myeloid leukemia and chronic lymphocytic leukemia: a case report

Abstract

BackgroundThe simultaneous Occurrence of chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML) has been rarely reported. Most of these cases have been occurring more frequently as a secondary event in patients receiving chemotherapeutic agents for CLL.Case presentationWe describe a case of a 77-year-old man who presented with fatigue, pallor and lower limb pain and weakness. Initial laboratory studies showed Hb 7.7 g/dl, WBC 279.6 × 109/1, PLT 143× 109/1. The peripheral blood (PB) smear examination showed circulating blast cells (20 %) cells and 50 % lymphocytes, with smudge cells.A bone marrow examination showed infiltration by two discrete abnormal cell populations, one represents the leukemic blast cells (60 %) and the other represents small mature lymphocytes (30 %). The immunologic phenotype of blasts was characterized by the co-expression of CD13, CD33, CD14, CD4, CD15, CD64, HLA-DR, CD11c. Lymphocytes were characterized by a typical CLL immunophenotype: CD19+, CD5+, CD23+, CD20+ (dim) and negative for FMC7, CD34, CD10 and TdT. Cytogenetic studies were negative for CLL and AML panels. PCR assays for AML specific genetic abnormalities were negative. Immunoglobulin gene analysis established the clonal nature of the B-cell expansion. A final diagnosis of concomitant CLL and AML(FAB: M5) was made.ConclusionWe have reported a case in which there was simultaneous presentation of AML and CLL. Both forms of leukemia were well documented by morphology, cytometric analysis and molecular studies. Our findings support the idea that this rare concurrence of AML and untreated CLL may represent two separate disease processes.

Diagnostics and Prognostication of Myelodysplastic Syndromes

“…This change determines that cases previously diagnosed as erythroid/myeloid AML are now included in the MDS group [ 27 ]. It is to be noted that, in the literature, cases of MDS developing in patients with untreated CLL are reported [ 28 29 ]. It is also important to come to an agreement on how to evaluate the myeloid blast percentage in suspect myeloid neoplasms presenting with the infiltration of lymphoma cells in the BM, using microscopy, to avoid the risk of the underestimation of myeloblasts in BM infiltrated by lymphoid cells and/or plasma cells.…”

Development of a myelodysplastic/myeloproliferative neoplasm-unclassifiable in a patient with acute myeloid leukemia: a case report and literature review

“…Although the simultaneous existence of two clones in a patient is possible, the incidence is very low and only sporadically reported. 25 , 26 Similarly, the presence of both acute and chronic leukemia in an individual is rare.…”

Myeloid neoplasms in the setting of chronic lymphocytic leukaemia/chronic lymphocytic leukaemia-like disease: a clinicopathological study of 66 cases comparing cases with prior history of treatment to those without

“…Likewise, CLL or CLL-like diseases are a group of B-cell neoplasms that demonstrate an indolent clinical course with a median survival of more than 10 years 1 2. During the protracted disease course, secondary malignancies can arise, including haematolymphoid neoplasms, with myeloid neoplasms being a frequent event 5–9 12–21. The pathogenesis of developing a myeloid neoplasm in this clinical setting has been the subject of debate, with therapy thought to be the cause in the majority of cases 5–9.…”

“…However, in the setting of CLL/SLL, the number of myeloid neoplasms attributed to CLL-type therapy is not significantly higher than that without treatment, raising a possibility of intrinsic predisposition for the development of myeloid neoplasms in this patient population. In fact, with routine application of ancillary tests, particularly flow cytometry in bone marrow examination, the incidental finding of unrecognised CLL or CLL-like B-cell neoplasm concomitant with a myeloid neoplasm has become a more common occurrence 12–22. At this time, the pathogenesis and clinical significance of myeloid neoplasms in the setting of CLL/SLL are not well understood, despite multiple published case series and case reports.…”