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Association of Chronic Lymphocytic Leukemia and Acute Myeloid Leukemia in Three Patients: Cases with the Concomitant Presence of Two Different Malignant Clones

Heba A Ahmed, Shereen P Aziz and Abeer Hassan

In this report we present three patients who are 70, 50 and 55 years of ages with complaints of fatigue, pallor, weakness and epistaxis. The Peripheral Blood (PB) smear and bone marrow aspiration (BMA) showed circulating blast cells, lymphocytes, and smudge cells. In first and second cases flow cytometric (FC) analysis demonstrated that blasts were associated with co-expression of Chronic Lymphocytic Leukemia (CLL) and Acute Myeloid Leukemia (AML) immunophenotyping. In the third case Bone Marrow Biopsy (BMB) showed megaloblastic and dysplastic changes in eryhtroid, megakaryocytic and myeloid lineages. The concomitant occurrence of AML and CLL might be a common stem cell defect, a consequence of leukomogenic factors or a genetic predisposition in some patients. CLL development after the diagnosis of Myelodysplastic Syndrome (MDS) or AML was not reported in the literature. From this point of view this is the first case in the literature. Duration of the treatment, intensity and nature of the given agent might explain development AML but not CLL. However, CLL might have developed during the initial leukomogenic process of the disease. The two cases support the idea that AML and CLL might demonstrate two separate disease processes originating from abnormal different clones.