COEXISTENCE OF ACUTE MONOBLASTIC LEUKEMIA IN A CHRONIC LYMPHOCYTIC LEUCEMIA: CASE REPORT

Abstract

Background: Chronic lymphocytic leukemia (CLL) is associated with an increased risk of other malignancies, such as skin and. second hematological malignancies. In the majority of cases, this usually involves a disease transformation to an aggressive non-Hodgkin lymphoma, multiple myeloma or prolymphocytic lymphoma. CLL patients can rarely develop acute myeloid leukemia (AML). We have reported a case in which there was simultaneous presentation of AML and CLL. Case report: A 78-year-old man presented with tiredness and mucosal bleeding. Laboratory evaluation revealed a white blood count of 220,970 μ/l with 4% of blasts,69% lymphocytes and 20% monocytes, hemoglobin of 6.7 g/dl, platelet count of 29,000 μ/l. A bone marrow aspirate revealed markedly hypercellular bone marrow with 21% blasts and promonocytes and 47% mature lymphocytes. A peripheral blood flow cytometry demonstrated a mature CD5 and CD23 positive B-cell population expressing CD19, low-density CD 20, CD11c, CD25, CD81, CD39 and lambda light chains at 53.02% of lymphocytes, consistent with B-CLL.; In addition, a second population showed CD33, CD13 low-density, CD11b, CD64, CD14, CD36, HLA-DR, CD56, CD123, CD11c, CD38 and CD9 positives in 39.35% of immature monocytes, consistent with acute monoblastic leukemia. Cytogenetics on bone marrow aspirate showed 48,XY, +4,+8[18] / 46,XY [2]. Conclusion: The present report highlights the rare possibility of the development of a myeloid malignancy in a patient with lymphoid malignancy. Most of these cases more frequently present as a secondary event in patients receiving chemotherapeutic agents for CLL.Knowledge of this rare association is the key to timely and accurate diagnosis, particularly in patients with atypical presentation. Existing literature demonstrates that AML may also develop concurrently or even after the diagnosis of treatment-naïve CLL patients. Further studies of such patients have potential to provide insight into the pathogenesis of myeloid as well as lymphoid malignancies.