Treatment-Related Myeloid Neoplasms Secondary to Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL): A Clinicopathologic Study of 8 Cases
Maggie M Stoecker, Qin Huang, Elizabeth L Boswell, Endi Wang. Duke University Medical Center, Durham, NC; City of Hope Medical Center, Duarte, CA
Background: Therapy-related acute myeloid leukemia (t-AML) and myelodysplastic syndrome (t-MDS) following fludaribine-based therapies for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have been reported over the past decade. We describe our experience with t-AML and t-MDS in patients treated for CLL/SLL with a variety of therapeutic agents in 8 cases.
Design: Cases of t-AML and t-MDS in patients treated for CLL/SLL were identified in our diagnostic services. Clinical information and pathologic findings were retrospectively analyzed.
Results: 8 cases (age 34-80 years, median 58 years), including 5 t-MDS and 3 t-AML, were identified. Treatments included a combination of alkylating, antimetabolite, immunomodulatory, monoclonal antibody, tyrosine kinase inhibitor, and anti-inflammatory agents. Rituximab and fludarabine were used in 8/8 (100%) and 7/8 (88%) cases, respectively. In 1 case, only prednisone and rituximab were used. All cases had hypercellular marrows, and 7/8 (88%) had erythroid dysplasia. The median time to develop t-MDS/AML was 34 months (range 21-99).
|Age/Sex||CLL Therapy||Type of Myeloid Neoplasm||Latency (Months)||Dysplasia||CLL Persistence||Cytogenetics||Follow-up, Survival (Months)|
|50/F||F,C,R||t-MDS||21||E||N||46, X, inv(X)||SCT, 26+|
|80/M||F,C,R||t-AML||39||E, My||N||45, XY, -7||15|
|64/M||Ch, F, C, Pe, R, A, L, B||t-AML||99||E||Y (<1%)||Complex||2|
|57/F||Ch, F, C, R||t-MDS||29||E||Y (45%)||ND||Richter transformation, 47|
|58/F||F,C,R,B||t-MDS||96||M||Y||ND||Transformed to AML|
|58/M||F,R,D||t-AML||84||E, M, My||Y (5-10%)||Complex||U|
|76/F||R, P||t-MDS||24||E, M||Y (50%)||Complex||U|