SIMULTANEOUS OCCURRENCE OF B-CELL CHRONIC LYMPHOCYTIC-LEUKEMIA AND CHRONIC MYELOID-LEUKEMIA WITH FURTHER EVOLUTION TO LYMPHOID BLAST CRISIS

The coexistence of chronic myeloid leukemia (CML) and B-cell chronic l ymphocytic leukemia (CLL) in the same patient is rare. A 71-year-old w oman developed a B-lineage lymphoid blast crisis at 18 months after di agnosis of Ph-positive CML. At this time, a lymphoid cell population w ith morphologic and immunophenotypic features of CLL was demonstrated. The retrospective review of the tests performed at diagnosis and ther eafter disclosed the presence of lymphoid nodules in the initial bone marrow biopsy in the absence of lymphocytosis. Subsequently, there was an appearance of moderate lymphocytosis in the following months. Ther efore, diagnosis of CML and coexistent CLL was established. Although a transient remission of blast crisis was achieved, blast cells reappea red two months later and the patient died shortly afterwards. Molecula r studies of the immunoglobulin heavy chain gene (J(H)) rearrangement pattern point to the origin of the diseases in two different cell clon es. In addition, previously published cases of simultaneous CLL and CM L are reviewed. (C) 1997, Ferrata Storti Foundation.