Chronic Myeloid Leukemia as a Secondary Malignancy after Lymphoma in a Child. A Case Report and Review of the Literature

Abstract

Background: Philadelphia chromosome-positive chronic myeloid leukemia (CML) in children is very rare. CML occurring as a secondary malignancy in individuals treated for diffuse large B-cell lymphoma (DLBCL) is also rare. Case Report: We present the case of a 5-year-old female patient who developed a right orbital mass that was diagnosed as DLBCL. 9 months after receiving treatment for DLBCL, she presented with a white cell count of 250,000/mm³. Peripheral blood and bone marrow (BM) evaluation revealed a myeloproliferative disorder. Cytogenetic and molecular studies demonstrated the presence of t(9;22). CML following DLBCL has not been previously described in the younger population. To our knowledge, this is the first report of a child who developed a CML as a second malignancy after DLBCL. Therapy-related CML and non-therapy-related secondary CML are discussed as potential explanations of this highly unusual clinical presentation. Conclusion: Hematological disorders such as CML may occur after lymphomas. With the increased use of BM cytogenetic studies during staging for lymphoid malignancies, future studies may be able to clarify the question of whether the CML clone in some of these patients existed before treatment for lymphoma.

Pediatric secondary chronic myeloid leukemia following cardiac transplantation for anthracycline‐induced cardiomyopathy

“…Three retrospective studies and several individual case reports reviewed cases of secondary CML in a variety of diseases including untreated malignancies, immunosuppression therapies and solid organ transplants without underlying malignancy [3,4,[10][11][12][13]. None of the studies could render an association between chemotherapy and secondary CML.…”

Definition, Epidemiology, Pathophysiology, and Essential Criteria for Diagnosis of Pediatric Chronic Myeloid Leukemia

“…Probably only exposure to higher radiation doses causes CML. Following irradiation and/or chemotherapy applied in the context of the treatment of a malignancymostly Hodgkin and Non-Hodgkin lymphomas -CML has been observed as secondary malignancy rarely in some adult and pediatric cases [46][47][48][49]. As the incidence of pediatric CML is not increased in healthy siblings, and especially not in twin pairs with one child affected from CML, genetic factors are of greater importance in the etiology of CML [50][51][52][53].…”

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

“…Epidemiologic studies performed in large series have shown the possibility of secondary CML occurrence in cases of HD, NHL, and various solid tumors [5,6,7,8,9]. Usually, the median latency of time between the 2 diseases was 60 months, and the majority of the patients were diagnosed with CML in the chronic phase.…”