Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: Molecular evidence of two separate diseases

Abstract

Acute myeloid leukemia (AML) occurring concurrently with or after untreated chronic lymphocytic leukemia (CLL) is rare. We report a case of a 59-year-old man who was evaluated for anemia, thrombocytopenia, and leukocytosis with circulating blasts. On the basis of the morphology and immunophenotyping results, a preliminary diagnosis of chronic myelomonocytic leukemia with concurrent CLL was considered. Subsequently, cytogenetic analysis of the leukemic blood specimen revealed inv(16)(p13.1q22) with secondary trisomy 22 in a sideline clone. Fluorescence in situ hybridization confirmed the CBFb rearrangement associated with inv(16) in myeloblasts and myelomonocytic cells, but not in CLL cells. Therefore, a final diagnosis of AML with inv(16) with concurrent CLL was made. After standard chemotherapy for AML, the patient achieved complete remission for both his AML and CLL. The unique aspects of this case include concomitant AML and CLL, which do not share clonality, complex cytogenetic abnormalities with trisomy 22 as a secondary abnormality associated with inv(16), and achievement of remission for both AML and CLL by AML chemotherapy regimen. This case also represents one of the rare instances where a diagnosis of AML can be established even when the blast percentage in the marrow and blood is less than 20%. Am. J. Hematol. 81:963-968, 2006. V V C 2006 Wiley-Liss, Inc.

Association of Chronic Lymphocytic Leukemia and Acute Myeloid Leukemia in Three Patients: Cases with the Concomitant Presence of Two Different Malignant Clones

“…Our cases support the idea that AML and CLL might demonstrate two separate disease processes, which is CLL originates from abnormal CD5+CD19 positive lymphoid clone whereas AML originates from myeloid from CD34, CD117, CD13, CD33, and MPO positive myeloid clone. Lu CM et al showed that in a patient AML and CLL developed from different clones [13]. We only showed immunophenotypic features of AML and CLL were different.…”

Treatment-related acute myeloid leukemia in a chronic lymphocytic leukemia patient: role of fludarabine?

“…Therapy-related acute monoblastic leukemia (M5) in CLL, as in the present case, has rarely been reported [Lavabre-Bertrand et al 1989]. Our review of previously published cases demonstrates that AML and CLL may be diagnosed concurrently or after a variable latency period (<2-13 years) [Bracey et al 1989;Robertson et al 1994;Mateu et al 1997;Meloni et al 2000;Molero et al 2001;Lam et al 2005;Lu et al 2006;Hatoum et al 2007;Park et al 2009]. Rarely, the development of AML may not manifest with peripheral circulating blasts [Robertson et al 1994].…”

“…The present patient did not have any high-risk genetic mutations, however, overt DIC may reflect the aggressive disease manifestation. A few cases with normal karyotype or good-risk cytogenetics such as t(15;17) or inv(16) have also been reported [Molero et al 2001;Lu et al 2006;Hatoum et al 2007]. Unlike the majority of patients, who have poor outcomes [Bracey et al 1989;Robertson et al 1994;Mateu et al 1997], patients with good-risk cytogenetics may have good outcomes [Molero et al 2001;Lu et al 2006;Hatoum et al 2007;Park et al 2009].…”

Myelodysplastic Syndrome in a Patient With Untreated Chronic Lymphoproliferative Neoplasm

“…18,19 Postoje i hipoteze da ove bolesti nastaju istodobno iz istog klona matične stanice ili je, pak, riječ o dva odvojena procesa. 7,15,[19][20][21][22][23][24] Istodobno prisutni KLL i MDS dijagnostički su izazov. U bolesnika s KLL-om i citopenijom treba pomišljati i na istodobno prisutan MDS.…”