JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
any previous treatment, either for CLL or for other co-existing conditions. In our patient, further evaluation of CLL by FISH studies detected a deletion of 13q14.3. Common cytogenetic abnormalities associated with CLL include trisomy 12, del(13) (q14.3), del(11)(q22.3), and del(17)(p13.1). Isolated deletion of 13q14.3 as seen in our patient is considered a favorable prognostic marker in the absence of other adverse genetic markers. Based on the morphology, immunohistochemistry, cytogenetic andmolecular analysis, it is apparent that our patient had co-existence of two unrelated hematological malignancies. APL is a hematological emergency that is managed the same whether the disease is de novo or therapy-related. Treatment with ATRA should be initiated immediately. Anthracycline- based treatment and arsenic trioxide (ATO) as part of induction chemotherapy is recommended in patients with adequate cardiac function. Since disseminated intravascular coagulation (DIC) occurs in up to 85% of patients, coagulation studies should be monitored frequently, and DIC should be corrected aggressively by transfusion with fresh frozen plasma (FFP) and cryoprecipitate.
11. Molero T, Lemes A, De La Iglesia S, Gómez Casares MT, del Mar Perera M and Jiménez S. Acute promyelocytic leukemia developing after radiotherapy for prostate cancer in a patient with chronic lymphocytic leukemia. Cancer Genetics and Cytogenetics 2001;131:141-143. 12. Gershkevitsh E, Rosenberg I, Dearnaley DP and Trott KR. Bone marrow doses and leukemia risk in radiotherapy of prostate cancer. Radiother Oncol 1999;53:189-197. Jingdong Su, MD, is associated with the Department of Hematology/ Oncology, LSU Health Sciences Center-Shreveport; Diana Veillon, MD, is associated with the Department of Pathology, LSU Health Sciences Center-Shreveport; Rodney Shackelford, MD , is associated with the Department of Hematology/Oncology, LSU Health Sciences Center- Shreveport; James Cotelingam, MD , is associatedwith the Department of Pathology, LSU Health Sciences Center-Shreveport; Hazem El-Osta, MD , is associated with the Department of Hematology/Oncology, LSU Health Sciences Center-Shreveport; GlennMills, MD , is associated with the Department of Hematology/Oncology, LSU Health Sciences Center- Shreveport; Reinhold Munker, MD , is associated with the Department of Hematology/Oncology, LSU Health Sciences Center-Shreveport; Srinivas Devarakonda, MD , is associated with the Department of Hematology/Oncology, LSU Health Sciences Center-Shreveport.
CONCLUSION
We report herein an extremely rare case of concurrent APL and CLL. To the best of our knowledge, this is the first report of APL presenting simultaneously with CLL in a patient without prior treatment. In addition to the distinct morphology of the leukemic components, the diagnosis was confirmed by molecular genetic and flow cytometric studies. Aggressive treatment should be initiated as soon as APL is suspected to avoid serious complications.
REFERENCES
1. Molica S. Second neoplasms in chronic lymphocytic leukemia: incidence and pathogenesis with emphasis on the role of different therapies. Leuk Lymphoma . 2005;46:49-54. 2. Tsimberidou A, Wen S, McLaughlin P, et al. Other malignancies in chronic lymphocytic leukemia/small lymphocytic lymphoma. J Clin Oncol. 2009;27:904-910. 3. Pallicardo N, O’Brien S, Estey EH, et al. Secondary acute promyelocytic leukemia. Characteristics and prognosis of 14 patients from a single institution. Leukemia. 1996;10:27-31 4. Leone G, Mele L, Pulsoni A, Equitani L, and Pagano L. The incidence of secondary leukemias. Haematologica, 1999;84:937-945. 5. Bhavnani M, Azzawi S, Liu J, et al. Therapy-related acute promyelocytic leukemia. Br J Haematol . 1994;86:231-232. 6. Chen Z, Mostafavi HS, Shevrin DH, et al. A case of therapy-related extramedullary acute promyelocytic leukemia. Blood. 1999;9:3015-3021. 7. Ramkumar B, Chadha MK, Barcos M, Sait SN, Heyman MR and Baer MR. Acute promyelocytic leukemia after mitoxantrone therapy for multiple sclerosis. Cancer Genetics and Cytogenetics 2008;182:126-129. 8. Xue Y, Guo Y, and Xie X. Translocation t(7;11)(P15;P15) in a patient with therapy-related acute myeloid leukemia following bimolane and ICRF-154 treatment for psoriasis. Leukemia Research. 1997;21:107-109. 9. Gottardi M, Gatei V, Degan M, et al. Concomitant chronic lymphocytic leukemia and acute myeloid leukemia: evidence of simultaneous expansion of two independent clones. Leuk Lymphoma . 2006;47:885-889. 10. Lu CM, Murata-Collins JL, Wang E, Siddiqi I and Lawrence H. Concurrent acute myeloid leukemia with inv(16)(p13.1q22) and chronic lymphocytic leukemia: molecular evidence of two separate disease. Am Hematol. 2006;81:963-968.
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