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Butt A, Quddus R, Ali N. Concomitant Essential Thrombocythemia and Mature B -Lymphoproliferative Disorder in a Patient. Int J Hematol Oncol Stem Cell Res 2021; 15:255-259. [PMID: 35291667 PMCID: PMC8888362 DOI: 10.18502/ijhoscr.v15i4.7481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
A-64-year old male presented with cough, weight loss, and maculopapular rash for 15-20 days. On examination, he was found to have cervical lymphadenopathy and splenomegaly. His leukocyte count was 62.1x109/L, platelets were 1169x109/L and LDH was 816 IU/L. Peripheral blood film showed a leukoerythroblastic picture with thrombocytosis. He was started on hydroxyurea and allopurinol. Subsequently, bone marrow evaluation was done which depicted increased lymphoid cells with an M:E ratio of 4:1. Cellular areas exhibited an increase in myeloid precursors along with prominent lymphoid cells and abundant megakaryocytes. Immunohistochemistry showed an increase in B-lymphocytes. Grade MF-2 reticulin fibrosis was noted. Overall findings suggested essential thrombocythemia (ET). On flow cytometry, CD45-positive lymphoid cells population was 31% and showed reactivity to Pan-B-markers with lambda light chain restriction. Janus Kinase 2 (JAK 2) mutation was detected while BCR-ABL1 translocation was negative. A diagnosis of ET progressing to myelofibrosis and mature B-lymphoproliferative disorder was made. Hydroxyurea and allopurinol were stopped while ruxolitinib was introduced and 2.5 years later he remains stable on this treatment.
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Affiliation(s)
- Ayesha Butt
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - Natasha Ali
- Aga Khan University Hospital, Karachi, Pakistan
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2
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Kim H, Jang W, Shin S, Park J, Kim M, Kim Y, Han K, Lee GD, Won H, Yang YJ. Two cases of concurrent development of essential thrombocythemia with chronic lymphocytic leukemia, one related to clonal B-cell lymphocytosis, tested by array comparative genomic hybridization. Int J Hematol 2014; 101:612-9. [PMID: 25491494 DOI: 10.1007/s12185-014-1713-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 12/19/2022]
Abstract
We present two cases of concurrent development of essential thrombocythemia (ET) with chronic lymphocytic leukemia (CLL) and one related to clonal B-cell lymphocytosis (CBL). Both patients were referred for lymphocytosis and thrombocytosis. A bone marrow biopsy revealed infiltration of small, mature lymphocytes and megakaryocytic hyperplasia. Flow cytometric immunophenotyping and immunoglobulin (IG) gene clonality tests revealed clonal B lymphocytes. Both patients were positive for the JAK2 V617F mutation in whole bone marrow aspirate. The JAK2 V617F mutation was present in isolated B lymphocytes of patient 1, but not patient 2. Cytogenetics were normal in both patients. An array comparative genomic hybridization (CGH) analyses of B cells revealed a gain of 4q28.3, which is reported in non-Hodgkin's lymphoma, in patient 1, and deletion 22q11.22, which is associated with CLL, and a gain of Xp22.31 in patient 2. In both patients, B cells showed no myeloproliferative neoplasm (MPN)-specific genetic abnormalities. These results suggest that different oncogenic mechanisms in each cell lineage may underlie the concurrent development of ET and CLL (or CBL). Array CGH may be helpful in identifying the pathogenic mechanism in cases of concurrent development of lymphoid neoplasm and MPN.
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Affiliation(s)
- Hyunjung Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, 301-723, Korea (South)
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3
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Trifa AP, Cucuianu A, Popp RA, Paţiu M, Selicean C, Militaru MS, Pop IV. Concomitant Myeloproliferative and Lymphoid Neoplasms in Two Patients Positive for JAK2 V617F Mutation. Case Report and Literature Review. Indian J Hematol Blood Transfus 2014; 30:120-3. [PMID: 25332555 DOI: 10.1007/s12288-013-0281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/01/2013] [Indexed: 12/22/2022] Open
Abstract
The coexistence of both myeloproliferative and lymphoproliferative neoplasms in the same patient is an uncommon finding. We report two patients who presented such an association. The first patient was initially diagnosed with essential thrombocythemia, developing a clinical and haematological picture consistent with chronic lymphocytic leukaemia several years afterwards. The second patient was diagnosed concomitantly with polycythaemia vera and chronic lymphocytic leukaemia. Both patients were positive for the JAK2 V617F mutation. In the first patient the chronic lymphocytic leukaemia was asymptomatic, stage A, and did not require any additional treatment, while the second patient presented with generalized large lymphadenopathy (stage B) and chronic lymphocytic leukaemia-related symptoms, requiring chronic lymphocytic leukaemia-directed treatment. It is unclear whether there is a pathogenetic link between the myeloproliferative and lymphoproliferative diseases encountered in these patients, both being probably the result of random mutations occurring in distinct initiating cells. However, given the higher risk of lymphoproliferative neoplasms development in myeloproliferative neoplasms patients reported in larger studies, the genomic instability characteristic to myeloproliferative neoplasms may play a role in subsequent lymphoproliferative neoplasms occurrence.
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Affiliation(s)
- Adrian P Trifa
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, 6, Pasteur Street, 400349 Cluj-Napoca, Romania
| | - Andrei Cucuianu
- Department of Haematology, "Ion Chiricuţă" Cancer Institute, Cluj-Napoca, Romania
| | - Radu A Popp
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, 6, Pasteur Street, 400349 Cluj-Napoca, Romania
| | - Mariana Paţiu
- Department of Haematology, "Ion Chiricuţă" Cancer Institute, Cluj-Napoca, Romania
| | - Cristina Selicean
- Department of Haematology, "Ion Chiricuţă" Cancer Institute, Cluj-Napoca, Romania
| | - Mariela S Militaru
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, 6, Pasteur Street, 400349 Cluj-Napoca, Romania
| | - Ioan V Pop
- Department of Medical Genetics, "Iuliu Haţieganu" University of Medicine and Pharmacy, 6, Pasteur Street, 400349 Cluj-Napoca, Romania
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4
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Coexistence of Chronic Lymphocytic Leukemia and Myeloproliferative Neoplasm. Case Rep Oncol Med 2014; 2014:512928. [PMID: 25258688 PMCID: PMC4166643 DOI: 10.1155/2014/512928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/30/2014] [Accepted: 08/13/2014] [Indexed: 11/17/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the Western world. Host immune surveillance caused mainly by the disease itself is speculated to be responsible for high incidence of secondary neoplasms. However, the simultaneous occurrence of CLL and myeloproliferative disorder in the same patient is extremely rare. In the present report, a case of an 81-year-old man who was diagnosed with chronic lymphocytic leukemia and concomitant essential thrombocythemia is presented. We describe the morphologic, immunophenotypic, cytogenetic, and molecular findings in this patient. We also review the current literature.
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Robak T. Second Malignancies and Richter's Syndrome in Patients with Chronic Lymphocytic Leukemia. Hematology 2013; 9:387-400. [PMID: 15763979 DOI: 10.1080/10245330400018599] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Second malignancies are frequent complications in patients with chronic lymphocytic leukemia (CLL). Patients with this leukemia may develop large cell lymphoma (LCL) known as Richter's syndrome (RS). RS occurs in CLL patients of about 3% and may develop in a single lymph node or more often in a group of nodes. However, in some patients extranodal localization of aggressive lymphoma in RS has been observed. Besides LCL, Hodgkin's disease, prolymphocytoid leukemia, multiple myeloma and acute lymphoblastic leukemia may also occur as RS variants. The origin of lymphoid cells in RS remains tentative. However, CLL and RS originate from the same clone for some patients, whereas, in other patients cells of aggressive lymphoma do not have the features of the same clone as the CLL cells. The prognosis of RS is poor. Survival in different studies will be usually 2-5 months. The secondary development or coexistence of myeloproliferative disorders or myelodysplastic syndrome and solid tumors have also been rarely documented in CLL patients. It is of great concern that therapy may further increase the risk of a second neoplasm. However, until now, there are no clear evidence that alkylating agents or purine nucleoside analogs may be associated with an increased incidence of second malignancies in patients with CLL. In this review, epidemiology, biology, clinical characteristic and treatment approaches in RS and other secondary neoplasms in patients with CLL are discussed.
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MESH Headings
- Cell Lineage
- Disease-Free Survival
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/therapy
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Pabianicka, Poland.
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Hauck G, Jonigk D, Kreipe H, Hussein K. Simultaneous and sequential concurrent myeloproliferative and lymphoproliferative neoplasms. Acta Haematol 2012; 129:187-96. [PMID: 23257916 DOI: 10.1159/000342484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 08/08/2012] [Indexed: 11/19/2022]
Abstract
Concurrent manifestation of two chronic-stage myeloid and lymphoid/plasmacytoid neoplasms in one patient is rare and occurs in ≤1% of patients. There has been no systematic analysis of which combinations are frequent/infrequent and whether two concurrent diseases in one patient are clonally related or represent independent diseases. We therefore characterised a series of cases from our own archive (n = 65) and collected a large number of previously reported cases of patients in whom myeloid and lymphoid/plasmacytoid neoplasms co-occurred (n = 185). The most frequent combination was Philadelphia chromosome-negative myeloproliferative neoplasm with concurrent B cell chronic lymphocytic leukaemia, accounting for approximately 50% of double-disease patients. We compared the quantity of unsorted bone marrow cell-derived JAK2(V617F) and KIT(D816V) alleles with the quantity of the lymphoid/plasmacytoid compartment and analysed a subfraction of cases with fluorescence in situ hybridisation. Although a common aberrant progenitor has been reported in some cases in the literature, we found evidence of two independent chronic-stage myeloid and lymphoid/plasmacytoid neoplasms.
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MESH Headings
- Amino Acid Substitution
- Female
- Humans
- Janus Kinase 2/genetics
- Janus Kinase 2/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Mutation, Missense
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Neoplasms, Second Primary/pathology
- Proto-Oncogene Proteins c-kit
- Retrospective Studies
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Affiliation(s)
- Gesa Hauck
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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7
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Laurenti L, Tarnani M, Nichele I, Ciolli S, Cortelezzi A, Forconi F, Rossi D, Mauro FR, D'Arena G, Del Poeta G, Montanaro M, Morabito F, Musolino C, Callea V, Falchi L, Tedeschi A, Ambrosetti A, Gaidano G, Leone G, Foà R. The coexistence of chronic lymphocytic leukemia and myeloproliperative neoplasms: a retrospective multicentric GIMEMA experience. Am J Hematol 2011; 86:1007-12. [PMID: 21953617 DOI: 10.1002/ajh.22171] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/09/2022]
Abstract
Although the coexistence of chronic lymphocytic leukemia (CLL) and myeloproliferative neoplasms (MPN) has been sporadically reported in the literature, no systematic studies on this disease association are available. We retrospectively analyzed 46 patients affected by CLL/MPN referred by 15 Italian GIMEMA centers. The aim of this retrospective multicenter study was to define the following: clinico-biological characteristics, possible familiarity, clinical course of both diseases, and influence of MPN chemotherapy on the course of CLL. Among 46 patients, 30 patients were males, 16 patients were females; median age was 71 years. Only one case had familiar CLL. Myeloproliferative disorders consisted of essential thrombocytemia in 18 cases, polycythemia vera in 10 cases, chronic myeloid leukemia in 9 cases, primary myelofibrosis in 6 cases, and MPN/myelodysplastic syndrome in 3 cases. The lymphoproliferative disorder was diagnosed as monoclonal B-cell lymphocytosis in 8 patients and as Binet Stage A CLL in 38 patients. After a median follow-up of 49 months, 9 patients experienced progressive CLL and only 6 patients required treatment after a median of 57.5 months. The biological profile confirmed a subset of low-risk CLL. Twenty patients received chemotherapy for MPN without influence on the course of CLL: lymphocyte counts remained unchanged after 3, 6, and 12 months of treatment. This series is the largest so far reported in literature. The diagnosis of concomitant CLL/MPN is a rare event and lymphoproliferative disorders present a clinical indolent course with a low-risk biological profile. MPN therapy does not interfere with the prognosis of patients with CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease Progression
- Female
- Humans
- Incidence
- Italy/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Lymphocytosis/diagnosis
- Lymphocytosis/physiopathology
- Male
- Medical Records
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/drug therapy
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/physiopathology
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/drug therapy
- Myeloproliferative Disorders/epidemiology
- Myeloproliferative Disorders/physiopathology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/physiopathology
- Oncology Service, Hospital
- Prognosis
- Retrospective Studies
- Time Factors
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Affiliation(s)
- Luca Laurenti
- Hematology Institute, Catholic University, Largo A. Gemelli 8, Rome, Italy.
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8
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Aquino-Esquadro L, Mehendale S, Kadkol S, Rondelli D, Gaitonde S. JAK2 V617F Positive Essential Thrombocythemia Complicated by B-cell Chronic Lymphocytic Leukemia: An Uncommon Association and Diagnostic Pitfall. Lab Med 2011. [DOI: 10.1309/lmo806vywvtsubtv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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9
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Kodali S, Chen C, Rathnasabapathy C, Wang JC. JAK2 mutation in a patient with CLL with coexistent myeloproliferative neoplasm (MPN). Leuk Res 2009; 33:e236-9. [PMID: 19625083 DOI: 10.1016/j.leukres.2009.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 06/22/2009] [Accepted: 06/25/2009] [Indexed: 11/18/2022]
Abstract
JAK2 mutation has not been described in patients with chronic lymphocytic leukemia (CLL). We found JAK2 mutation in a patient with CLL and coexisting myeloproliferative neoplasm (MPN). In this patient, we demonstrated the presence of the JAK2 mutation in CD34(+) progenitor cells, myeloid lineage cells, megakaryocytes, B lymphocytes but not in T lymphocytes. This case represents the first case report of JAK2 mutation in CLL and may also suggest that, JAK2 mutation most likely represents a secondary event from primary gene mutations involving the primitive stem cells which give rise to MPN and CLL. Furthermore, in this case, we believe that we are the first to demonstrate that JAK2 mutation in myeloid and B lymphoid cells but not T lymphocytes in a case of coexisting CLL and MPN.
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Affiliation(s)
- Srinivas Kodali
- Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA
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Tabaczewski P, Nadesan S, Lim SH. Zap-70 positive chronic lymphocytic leukemia co-existing with Jak 2 V671F positive essential thrombocythemia: a common defective stem cell? Leuk Res 2008; 33:854-5. [PMID: 18849073 DOI: 10.1016/j.leukres.2008.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Revised: 08/31/2008] [Accepted: 09/01/2008] [Indexed: 11/28/2022]
Abstract
Essential thrombocythemia (ET) co-existing with chronic lymphocytic leukemia (CLL) is extremely rare. We report two cases of ET with Jak 2 V617F in Zap-70+ CLL. ET is a myeloproliferative stem cell disease. Zap-70 expression in CLL correlates with non-mutated immunoglobulin genes. The occurrence of a less mature CLL in patients with a pluripotential stem cell disease raises the possibility that an initial "trigger hit" occurred in a pre-Jak 2 common early progenitor in these patients. Subsequent additional molecular events accumulated independently following myeloid and lymphoid differentiation, leading to the development of two diseases of likely identical origin but different lineages.
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Affiliation(s)
- Piotr Tabaczewski
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, United States
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