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Viswanathan K, Roboz G, Chadburn A, Mathew S. Chronic Myelogenous Leukemia Diagnosed in the Setting of Untreated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Int J Surg Pathol 2019; 28:216-224. [PMID: 31544558 DOI: 10.1177/1066896919876704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic myeloid leukemia (CML) is rarely reported to occur in treated chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). In this article, we report a woman in her 70s, diagnosed with CLL/SLL in 2000, untreated, who subsequently presented 12 years later with de novo CML, BCR-ABL1+. Her IGHV mutated CLL/SLL based on the initial sample in our laboratory showed homozygous and heterozygous 13q14.3 deletions, whereas her CML, at presentation, showed a 46,XX,t(9;22)(q34;q11.2)[7]/46,XX[18] karyotype with a p190 BCR-ABL1 transcript. The tumor burden of each clone varied with treatment, including when treated with dasatinib, used to target both clones. In addition, the cytogenetic abnormalities evolved over time and treatments and included acquisition of an extra chromosome 8 in the CML clone and a novel K1992T ATM missense mutation (47% allele frequency) in the CLL/SLL clone. The patient's last bone marrow biopsy, 5 years after her CML diagnosis and 17 years after the CLL/SLL diagnosis, showed residual CML with extensive involvement by CLL/SLL (80%). Cytogenetic studies showed a 46,XX karyotype, while FISH identified 13q14.3 deletion and the BCR-ABL1 translocation in the CLL/SLL and CML clones, respectively. To date, this is the fourth case of concurrent CML, BCR-ABL1+ arising in untreated CLL/SLL. Here we show dynamic variation in the size of the 2 clonal processes reflecting the variable responsiveness to specific therapies. In addition to the unusual BCR-ABL1+ p190 transcript in the patient's CML, a novel ATM K1992T mutation was identified in the CLL/SLL population.
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Affiliation(s)
| | - Gail Roboz
- NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Amy Chadburn
- NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Susan Mathew
- NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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2
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Nagao T, Takahashi N, Kameoka Y, Noguchi S, Shinohara Y, Ohyagi H, Kume M, Sawada K. Dasatinib-responsive chronic lymphocytic leukemia in a patient treated for coexisting chronic myeloid leukemia. Intern Med 2013; 52:2567-71. [PMID: 24240798 DOI: 10.2169/internalmedicine.52.0392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present a case of concurrent chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Two different clones, a Philadelphia (Ph) clone and a CLL clone with a 13q deletion, were identified using fluorescent in situ hybridization. Dasatinib was administered to inhibit Bcr-Abl and Lyn kinase. The patient exhibited a molecular response for CML and a partial response for CLL. To our knowledge, this is the first report to describe the occurrence of a gradual increase in the Bcr-Abl transcript level prior to the diagnosis of Ph-positive CML in an individual with CLL who was successfully treated with dasatinib as the first-line therapy.
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MESH Headings
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Chromosome Deletion
- Chromosome Disorders/genetics
- Chromosomes, Human, Pair 13/genetics
- Dasatinib
- Female
- Genes, abl
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/genetics
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Thiazoles/therapeutic use
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Affiliation(s)
- Takayo Nagao
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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3
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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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4
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Gargallo P, Cacchione R, Chena C, Dupont J, Garay G, Riveros D, Larripa I, Slavutsky I. Chronic lymphocytic leukemia developing in a patient with chronic myeloid leukemia: evidence of distinct lineage-associated genomic events. ACTA ACUST UNITED AC 2005; 161:74-7. [PMID: 16080961 DOI: 10.1016/j.cancergencyto.2005.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 01/11/2005] [Indexed: 11/20/2022]
Abstract
We describe the cytogenetic, fluorescence in situ hybridization (FISH), and molecular findings in a patient who developed a typical chronic lymphocytic leukemia (CLL) 20 months after the diagnosis of a Philadelphia (Ph)-positive chronic myeloid leukemia. Unstimulated bone marrow culture showed a 46,XX,t(9;22)(q34;q11) karyotype, and interphase FISH detected the presence of a BCR/ABL fusion signal in 13% of cells. On stimulated bone marrow culture, a normal karyotype and a 13q14 deletion by interphase FISH with D13S319 probe in 14% of the cells were found. Molecular studies detected the chimeric BCR/ABL messengers by nested reverse-transcriptase polymerase chain reaction. The B-cellular clone was documented by the presence of a clonal heavy chain immunoglobulin rearrangement. The coexistence of these two hematologic malignancies leads to questions about their cell(s) of origin. We provide evidence that CLL arose in a Ph-negative clone. The implications of these findings are discussed.
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MESH Headings
- Aged
- Aged, 80 and over
- B-Lymphocytes/pathology
- Cell Lineage
- Chromosome Aberrations
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 9/genetics
- Female
- Fusion Proteins, bcr-abl/genetics
- Gene Rearrangement
- Humans
- Immunoglobulin Heavy Chains
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Philadelphia Chromosome
- Translocation, Genetic/genetics
- Tumor Cells, Cultured
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Affiliation(s)
- Patricia Gargallo
- Departamento de Genética, Academia Nacional de Medicina, Pacheco de Melo 3081, Buenos Aires 1425, Argentina
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5
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Specchia G, Buquicchio C, Albano F, Liso A, Pannunzio A, Mestice A, Rizzi R, Pastore D, Liso V. Non-treatment-related chronic myeloid leukemia as a second malignancy. Leuk Res 2004; 28:115-9. [PMID: 14654074 DOI: 10.1016/s0145-2126(03)00182-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The characteristics of the very rare non-treatment-related chronic myeloid leukemia (nTr-CML) cases have never before been analyzed. The literature up to December 2002 was screened using the Medline database to identify cases of Tr-CML and nTr-CML. We considered five cases with nTr-CML identified among 270 newly diagnosed CML at our Department. Our report thus considers nine cases with nTr-CML compared to 77 affected by Tr-CML as a secondary neoplasm. The median age at the appearance of the first tumor was higher in nTr-CML patients compared to that of the Tr-CML group (P<0.0001). The median age at CML diagnosis was significantly higher in the nTr-CML than in the Tr-CML group (P<0.0001). The proportion of hematological malignancies as first tumor type was not different in the two groups (44% in nTr-CML versus 56% in Tr-CML). Our study underlines that nTr-CML as a second malignancy is a rare entity associated with elderly age.
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Affiliation(s)
- Giorgina Specchia
- Department of Haematology, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
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6
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Aguiar RC. Therapy-related chronic myeloid leukemia: an epidemiological, clinical and pathogenetic appraisal. Leuk Lymphoma 1998; 29:17-26. [PMID: 9638972 DOI: 10.3109/10428199809058378] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Second primary cancers represent an important complication of modern chemotherapy and radiotherapy. Therapy-related (tr) leukemias are among the most common second malignancies in both pediatric and adult populations. Whereas a reasonable amount of data is available regarding the epidemiology, molecular pathogenesis, clinical behavior and response to therapy of second primary acute leukemias, very little is known about therapy-related chronic myeloid leukemia (tr-CML). A better characterization of this entity could increase our understanding about the mechanisms of carcinogenesis, specially the induction of specific genetic abnormalities, e.g., BCR-ABL fusion, following chemotherapy and/or radiotherapy exposure, could facilitate the investigation of the kinetics of the development of CML, and also provide a model to study molecular events that might precede its development. Review of 32 tr-CML cases suggests that there are no clinically appreciable differences between tr-CML and de novo CML cases. Analysis of large epidemiological studies that investigated the risk of second primary leukemias has not shown any clear evidence of a higher risk of CML among individuals who underwent treatment for a primary cancer over the general population. The cancer-predisposing syndromes, the detection of BCR-ABL transcripts in healthy individuals, and the induction in vitro of BCR-ABL fusions by ionizing radiation, are all discussed in the context of tr-CML. Finally, the need for a large epidemiological study to specifically assess the risk of developing second primary CML after chemotherapy and/or radiotherapy is stressed.
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MESH Headings
- Antineoplastic Agents/adverse effects
- Humans
- Incidence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Radiation-Induced/epidemiology
- Leukemia, Radiation-Induced/etiology
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/etiology
- Radiotherapy/adverse effects
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Affiliation(s)
- R C Aguiar
- LRF Centre for Adult Leukaemia, Department of Haematology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
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Nanjangud GJ, Saikia TK, Chopra H, Kadam PR, Advani SH. Development of Ph positive chronic myeloid leukemia in a patient with chronic lymphocytic leukemia treated with total body irradiation: a rare association. Leuk Lymphoma 1996; 22:355-9. [PMID: 8819087 DOI: 10.3109/10428199609051769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Philadelphia (ph) chromosome positive chronic myeloid leukemia developed in a patient treated for chronic lymphocytic leukemia after treatment with total body irradiation. The role of radiation in the development of CML is discussed.
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MESH Headings
- Adult
- Chronic Disease
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/radiotherapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Male
- Neoplasms, Radiation-Induced/etiology
- Whole-Body Irradiation/adverse effects
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Affiliation(s)
- G J Nanjangud
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Bombay, India
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8
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Walgraeve D, Verhoef G, Stul M, Cassiman JJ, Mecucci C, Van den Berghe H, Boogaerts M. Chronic myelogenous leukemia after treatment with 131I for thyroid carcinoma. Report of a case and review of the literature. CANCER GENETICS AND CYTOGENETICS 1991; 55:217-24. [PMID: 1933823 DOI: 10.1016/0165-4608(91)90080-e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A patient who developed Philadelphia chromosome-positive chronic myelogenous leukemia (CML) 5 years after successful treatment for thyroid carcinoma, is reported. The Philadelphia chromosome was the typical 9;22 translocation. Southern blot analysis showed breakpoint cluster region rearrangement as observed in classical CML. Up to now, only two cases of CML have been reported following treatment for thyroid carcinoma. This rare complication has also been described after therapy for other malignancies. At present, it is not clear whether the development of CML after thyroid carcinoma represents a therapy-induced complication, a coincidence, or an increased susceptibility to secondary malignancies due to the malignant process itself.
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Affiliation(s)
- D Walgraeve
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
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Browett PJ, Pattinson J, Pinkney J, Hoffbrand AV, Norton JD. Gene probe analysis demonstrates independent clonal evolution of co-existent chronic myeloid and chronic lymphocytic leukaemia. Eur J Haematol 1988; 40:181-4. [PMID: 3278930 DOI: 10.1111/j.1600-0609.1988.tb00818.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe a case of Philadelphia-positive chronic myeloid leukaemia occurring simultaneously with B-cell chronic lymphocytic leukaemia in a 69-yr-old male. Gene probe analysis of DNA from both peripheral blood and bone marrow provided evidence for the independent evolution of 2 clones in this case, with a predominant population showing immunoglobulin heavy chain gene rearrangement and a smaller population showing a rearrangement within the breakpoint cluster region of chromosome 22.
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Affiliation(s)
- P J Browett
- Department of Haematology, Royal Free Hospital, Hampstead, London, U.K
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10
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Teichmann JV, Sieber G, Ludwig WD, Karow J, Ruehl H. Chronic myelocytic leukemia as a second neoplasia in the course of chronic lymphocytic leukemia. Case report and review of the literature. Leuk Res 1986; 10:361-8. [PMID: 3457222 DOI: 10.1016/0145-2126(86)90064-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient with chronic lymphocytic leukemia developed Ph1-positive chronic myelocytic leukemia after a 6-yr course of CLL. Chemotherapy for CLL consisted of chlorambucil and steroids, later vincristine and bleomycin; after resistance to these agents, cyclophosphamide, vincristine and prednisolone were applied. When CML was diagnosed, we found two morphologically distinct populations of malignant cells in the bone marrow; the Ph1-chromosome was identified, and immunological surface marker studies also demonstrated two distinct malignant cell populations. Up to now, only five cases of CML have been reported following CLL and one case accompanying it. Three patients were treated with cytostatic drugs, one patient by total body irradiation and two patients received no therapy. At present, it is not clear whether the development of CML during CLL represents a therapy-induced complication or an increased susceptibility to second malignancies due to the leukemic process itself or possibly to immunological deficiencies in CLL. Since two patients received no treatment for CLL, previous therapy does not seem to be a prerequisite for the development of CML.
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