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Chen Y, Yuan L, Lu X, Wang X, Zhang Q, Wang X, Zhao X. Efficacy of venetoclax and rituximab in the treatment of concurrent acute myeloid leukemia and untreated chronic lymphocytic leukemia: A case report and literature review. Oncol Lett 2024; 28:393. [PMID: 38966581 PMCID: PMC11223026 DOI: 10.3892/ol.2024.14526] [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: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 07/06/2024] Open
Abstract
To date, few cases of concurrent acute myeloid leukemia (AML) and untreated chronic lymphocytic leukemia (CLL) have been reported. Due to the complexity of the pathogenesis and the absence of a uniform treatment regimen, the associated prognosis remains poor. The present study reports the case of a 58-year-old male with asymptomatic leukocytosis, who was previously healthy with no malignancies. Flow cytometry analysis revealed protocytosis, monocytosis and monoclonal B lymphocytosis in a bone marrow specimen. Results of a gene rearrangement assay demonstrated positive immunoglobulin heavy-chain variable region gene status in monoclonal B lymphocytes. Thus, the patient was diagnosed with AML with maturation (AML-M2) that co-existed with untreated CLL. The normative daunorubicin (40 mg/m2 on days 1-3) and cytarabine (80 mg/m2 on days 1-7) regimen combined with venetoclax (400 mg on days 1-7) and rituximab (375 mg/m2 on day 0) was used as induction chemotherapy. The patient achieved morphological complete remission in both AML and CLL following the first course of chemotherapy. In addition, the present study retrospectively analyzed the data of 22 patients with concurrent AML and untreated CLL, and the results demonstrated that the median age at the time of AML diagnosis was 69 years (range, 52-86 years). Moreover, the male:female ratio was 6.33:1 and AML-M2 was the most frequent subtype at diagnosis. The presence of a complex karyotype was associated with the poorest prognosis, and patients who received venetoclax often exhibited an improved prognosis. In conclusion, the combination of venetoclax and rituximab improves the prognosis of patients with concurrent AML and untreated CLL.
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Affiliation(s)
- Yafang Chen
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
| | - Linyu Yuan
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
| | - Xinxiao Lu
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
| | - Xue Wang
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
| | - Qiuqiu Zhang
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
| | - Xiaofang Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China
- Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin 300060, P.R. China
| | - Xingli Zhao
- Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China
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Zhang LB, Zhang L, Xin HL, Wang Y, Bao HY, Meng QQ, Jiang SY, Han X, Chen WR, Wang JN, Shi XF. Coexistence of diffuse large B-cell lymphoma, acute myeloid leukemia, and untreated lymphoplasmacytic lymphoma/waldenström macroglobulinemia in a same patient: A case report. World J Clin Cases 2023; 11:4295-4305. [PMID: 37449216 PMCID: PMC10336997 DOI: 10.12998/wjcc.v11.i18.4295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The Coexistence of myeloid and lymphoid malignancies is rare. Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies. Synchronous diagnoses of diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML), and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in the same patient have not been reported. Here we report one such case.
CASE SUMMARY An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL. The bone marrow and peripheral blood contained two groups of cells. One group of cells fulfilled the criteria of AML, and the other revealed the features of small B lymphocytic proliferative disorder, which we considered LPL/WM. Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells, including ATM deletion, CCND1 amplification, mutations of MYD88 (L265P) and TP53, WT1 overexpression, and fusion gene of BIRC2-ARAP1, as well as complex chromosomal abnormalities. The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis.
CONCLUSION The coexistence of DLBCL, AML, and untreated LPL/WM in the same patient is extremely rare, which probably results from multiple steps of genetic abnormalities. Asymptomatic LPL/WM might have occurred first, then myelodysplastic syndrome-related AML developed, and finally aggressive DLBCL arose. Therefore, medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.
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Affiliation(s)
- Liu-Bo Zhang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Lu Zhang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Hong-Lei Xin
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Yan Wang
- Department of Pathology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Hong-Yu Bao
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Qing-Qi Meng
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Su-Yu Jiang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Xue Han
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Wan-Ru Chen
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Jian-Ning Wang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Xiao-Feng Shi
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
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