POSTER 46
ACUTE MYELOID LEUKEMIA ON TOP OF CHRONIC LYMPHOCYTIC LEUKEMIA: CASE
PRESENTATIONS AND LITERATURE REVIEW.
Ayman Youssef1,2, Lamiaa Reda1, Yasmine Ismail3, Reem Eshra1 and Ashraf Elghandour2,4,5
(1)Alexandria faculty of medicine, hematology unit, internal medicine department, Alexandria, Egypt
(2)Bone marrow transplantation unit, Alexandria university, Alexandria, Egypt
(3)Alexandria faculty of medicine., hematology unit, internal medicine department, Alexandria, Egypt
(4)Alexandria faculty of medicine, hematology unit, internal medicine deaprtment, Alexandria, Egypt
(5)Vice dean of postgraduate affairs, Alexandria faculty of medicine, Alexandria, Egypt
Objectives :
1. Define acute leukemia presentation when it occurs overlapping other hematologic
malignancies.
2. Molecular work up proposition for patients who develop double cancers and their risk
stratification.
3. Suggested therapeutic regimens that may address selective disease process or multiple
malignancies at the same time.
Subjects and methods :
A 46 year old female patient has presented with fever, bleeding gums, menorrhagia and multiple
ulcers in the groin and the buttocks. The medical archives have shown that the patient was
previously diagnosed with chronic lymphocytic leukemia (CLL) stage III four years ago and received
bendamustine/rituximab and achieved remission after six cycles of this protocol. The CBC done
showed Hb 63 g/L platelets 36000/ml and TLC 37000/ml, the presence of both clonal lymphocytes
and myeloblasts was further confirmed by the flowcytometery. Bone marrow biopsy was done and
showed the two clones; CLL and acute myeloid leukemia. She has received supportive transfusion
and antibiotics and her condition stabilized. Her cytogenetics was normal female karyotype 46,XX.
She has received cytarabine 100 mg/m2 for 7 days which resulted in decreasing the blast counts in
the peripheral blood however with flare of CLL clone that appeared as increased lymphocytosis and
enlarged lymph nodes which were smaller at presentation. The bone marrow blasts declined to 17%
from baseline of 76%. Then the patient received higher dose of cytarabine 1 g/m2/12 hr D1,3,5 and
again the blasts continued its decline however with resolution of the lymph nodes and lymphocytosis
with disappearance of CLL in the BM and blasts 11%. We decided to start FLAG (fludarabine,
cytarabine, G-CSF) protocol with her to target the two clone and bridge her to transplantation now
then she has a fully matched sibling donor, she has received it twice and achieved CR with negative
MRD every time and now she is being prepared for transplantation.
Results : It is clear that this patient did achieve CR with cytarabine based regimens alone however
she managed to with more aggressive protocols like FLAG.
Conclusion : Acute leukemia on top of indolent lymphoproliferative disorder is an uncommon finding,
yet previous case reports suggest therapy related etiology as the main cause. Our case has not
received chemotherapies known to induce therapy related leukemia (bendamustine, rituximab). The
possibility of TP53 mutation in one or both clones was high, however giving that the patient was
examined after achieving CR with FLAG this is likely not sensitive.
SCIENTIFIC
PROGRAMME
RARE SUBSETS OF
ACUTE LEUKAEMIA
TRACKING LEUKAEMIC
STEM CELLS (LSCs)
ROUTINE DIAGNOSIS
GENE EXPRESSION
AND MUTATIONAL
PROFILING
DEBATE 1 – ALL
PATIENTS WITH
INTERMEDIATE-RISK
AML MUST BE
TRANSPLANTED
INTERACTIVE
CASES 1 – MUTATION-BASED
THERAPY
OFF-LABEL
ROUNDTABLE –
SHOULD WE REALLY
USE NEW TARGETED
INHIBITORS AS SINGLE
AGENTS ?
ADDITION OF A 3RD
AGENT TO FRONTLINE
7+3
ROUNDTABLE –
CURATIVE OPTIONS
FOR OLDER AML
INTERACTIVE CASES 2
DEBATE 2 - BEST
TREATMENT FOR
NPM1-MUTATED AML IN
THE NEXT FUTURE ?
ALLOGENEIC
HAEMATOPOIETIC
STEM CELL
TRANSPLANTATION
(HSCT)
IMMUNOTHERAPY FOR
ACUTE LEUKAEMIA
DEBATE 3 - T-ALL:
WHERE ARE WE GOING
NOW?
SELECTED ABSTRACTS
AND CLINICAL
CASES FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES