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Huang C, Huang P, Luo X, He Z, Chen Y. Pediatric secondary chronic myelogenous leukemia in a patient with hemophagocytic lymphohistiocytosis carrying UNC13D, LYST, and ITK variants. Pediatr Blood Cancer 2024; 71:e31166. [PMID: 39030925 DOI: 10.1002/pbc.31166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
MESH Headings
- Humans
- Lymphohistiocytosis, Hemophagocytic/genetics
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Membrane Proteins/genetics
- Male
- Child
- Protein-Tyrosine Kinases/genetics
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/genetics
- Female
- Prognosis
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Affiliation(s)
- Chengshuang Huang
- Department of Emergency Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, P. R. China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
| | - Pei Huang
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, P. R. China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
| | - Xi Luo
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, P. R. China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
| | - Zhixu He
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, P. R. China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
| | - Yan Chen
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi, P. R. China
- Department of Pediatrics, Guizhou Children's Hospital, Zunyi, China
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Rivera D, Cui W, Gao J, Peker D, Zhang QY, Dewar R, Qiu L, Konoplev S, Hu Z, Sasaki K, Hu AY, E S, Liu M, Fang H, Wang W, Tang G, Apperley JF, Hochhaus A, Cortes JE, Khoury JD, Medeiros LJ, Jabbour E, Hu S. Aleukemic Chronic Myeloid Leukemia Without Neutrophilia and Thrombocytosis: A Report From the BCR::ABL1 Pathology Group. Mod Pathol 2024; 37:100406. [PMID: 38104892 DOI: 10.1016/j.modpat.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
Chronic myeloid leukemia (CML) is characterized by leukocytosis with left-shifted neutrophilia, basophilia, eosinophilia, and variable thrombocytosis. However, extremely rare cases of patients with CML without significant leukocytosis and thrombocytosis (aleukemic phase [ALP] CML, or CML-ALP) have been reported. Due to its rarity and limited awareness, there remains a significant knowledge gap concerning the pathologic diagnosis, disease progression, and optimal patient management and outcomes. In this multi-institutional study, we investigated 31 patients with CML-ALP. Over half (54.8%) of patients had a history of or concurrent hematopoietic or nonhematopoietic malignancies. At time of diagnosis of CML-ALP, approximately 26.7% of patients exhibited neutrophilia, 56.7% had basophilia, and 13.3% showed eosinophilia. The median number of metaphases positive for t(9;22)(q34;q11.2) was 15, with a median of 38.5% of interphase nuclei positive for BCR::ABL1 by fluorescence in situ hybridization. The median BCR::ABL1 level was 26.14%. Remarkably, 14 (45.2%) patients were initially misdiagnosed or not diagnosed before karyotype or fluorescence in situ hybridization information for BCR::ABL1 became available. Twenty-five patients received tyrosine kinase inhibitors (TKIs). One patient developed blast crisis while on TKI treatment 8 months after initial diagnosis. With a median follow-up time of 46.1 months, 20 of 22 patients who received TKI therapy and had detailed follow-up information achieved complete cytogenetic remission or deeper, 15 achieved major molecular remission or deeper, and 10 achieved molecularly undetectable leukemia. In conclusion, given the frequent occurrence of prior or concurrent malignancies, aleukemic presentation, and low level of t(9;22)(q34;q11.2)/BCR::ABL1, misdiagnosis or delayed diagnosis is common among these patients. While these patients generally respond well to TKIs, rare patients may develop blastic transformation. It is therefore important for pathologists and hematologists to be aware of this highly unusual presentation of CML to ensure timely diagnosis and appropriate management.
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MESH Headings
- Humans
- In Situ Hybridization, Fluorescence
- Leukocytosis
- Fusion Proteins, bcr-abl/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Thrombocytosis/genetics
- Eosinophilia
- Protein Kinase Inhibitors/therapeutic use
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Affiliation(s)
- Daniel Rivera
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Wei Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deniz Peker
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Qian-Yun Zhang
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | | | - Lianqun Qiu
- Department of Laboratory Medicine and Pathology, University of Washington Medicine, Seattle, Washington
| | | | - Zhihong Hu
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Shuyu E
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Meng Liu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hong Fang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jane F Apperley
- Centre for Haematology, Imperial College London, United Kingdom
| | - Andreas Hochhaus
- Department of Hematology/Oncology, Universitätsklinikum Jena, Jena, Germany
| | - Jorge E Cortes
- Georgia Cancer Center, Augusta University, Augusta, Georgia
| | - Joseph D Khoury
- Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, Omaha, Nebraska
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shimin Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Dores GM, Linet MS, Curtis RE, Morton LM. Risks of therapy-related hematologic neoplasms beyond myelodysplastic syndromes and acute myeloid leukemia. Blood 2023; 141:951-955. [PMID: 36379026 PMCID: PMC10082352 DOI: 10.1182/blood.2022018051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/19/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Graça M. Dores
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Martha S. Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rochelle E. Curtis
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Secondary chronic myeloid leukemia in a patient with CALR and ASXL1-mutated primary myelofibrosis. Int J Hematol 2022; 116:442-445. [DOI: 10.1007/s12185-022-03331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Luedke C, Zhao Y, McCracken J, Maule J, Yang LH, Jug R, Galeotti J, Siddiqi I, Gong J, Lu CM, Wang E. Myeloid neoplasms in the setting of chronic lymphocytic leukaemia/chronic lymphocytic leukaemia-like disease: a clinicopathological study of 66 cases comparing cases with prior history of treatment to those without. J Clin Pathol 2021; 75:292-301. [PMID: 33542108 DOI: 10.1136/jclinpath-2020-207334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/04/2022]
Abstract
AIMS Myeloid neoplasms occur in the setting of chronic lymphocytic leukaemia (CLL)/CLL-like disease. The underlying pathogenesis has not been elucidated. METHODS Retrospectively analysed 66 cases of myeloid neoplasms in patients with CLL/CLL-like disease. RESULTS Of these, 33 patients (group 1) had received treatment for CLL/CLL-like disease, while the other 33 patients (group 2) had either concurrent diagnoses or untreated CLL/CLL-like disease before identifying myeloid neoplasms. The two categories had distinct features in clinical presentation, spectrum of myeloid neoplasm, morphology, cytogenetic profile and clinical outcome. Compared with group 2, group 1 demonstrated a younger age at the diagnosis of myeloid neoplasm (median, 65 vs 71 years), a higher fraction of myelodysplastic syndrome (64% vs 36%; OR: 3.1; p<0.05), a higher rate of adverse unbalanced cytogenetic abnormalities, including complex changes, -5/5q- and/or -7/7q- (83% vs 28%; OR: 13.1; p<0.001) and a shorter overall survival (median, 12 vs 44 months; p<0.05). CONCLUSIONS Myeloid neoplasm in the setting of CLL/CLL-like disease can be divided into two categories, one with prior treatment for CLL/CLL-like disease and the other without. CLL-type treatment may accelerate myeloid leukaemogenesis. The risk is estimated to be 13-fold higher in patients with treatment than those without. The causative agent could be attributed to fludarabine in combination with alkylators, based on the latency of myeloid leukaemogenesis and the cytogenetic profile.
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Affiliation(s)
- Catherine Luedke
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yue Zhao
- Pathology, Duke University Medical Center, Durham, North Carolina, USA .,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jenna McCracken
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jake Maule
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lian-He Yang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Rachel Jug
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Galeotti
- Pathology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Imran Siddiqi
- Pathology, University of Southern California, Los Angeles, California, USA
| | - Jerald Gong
- Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chuanyi Mark Lu
- Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Endi Wang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Miyoshi I, Mori M, Yamasaki I, Daibata M. Is There an Entity of Radiation-Induced Chronic Myeloid Leukemia? Report of a Case and Brief Review of the Literature. J Clin Exp Hematop 2021; 60:24-25. [PMID: 32224562 PMCID: PMC7187678 DOI: 10.3960/jslrt.19044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Isao Miyoshi
- Department of Internal Medicine, Tosatamura Hospital, Kochi, Japan
| | - Masakazu Mori
- Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ichiro Yamasaki
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Japan
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Autore F, Sorà F, Chiusolo P, Annunziata M, Iurlo A, Cattaneo D, Galimberti S, Bajer JA, Sica S. 'Secondary chronic myeloid leukemia': comparison between patients previously exposed or not to chemo- and/or radiotherapy. Leuk Lymphoma 2019; 60:3584-3586. [PMID: 31294653 DOI: 10.1080/10428194.2019.1639162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Francesco Autore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Sorà
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Simona Sica
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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