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Myeloid neoplasms in the setting of chronic lymphocytic leukaemia/chronic lymphocytic leukaemia-like disease: a clinicopathological study of 66 cases comparing cases with prior history of treatment to those without.

Authors
  • Luedke, Catherine1
  • Zhao, Yue2, 3
  • McCracken, Jenna1
  • Maule, Jake1
  • Yang, Lian-He1, 3
  • Jug, Rachel1
  • Galeotti, Jonathan4
  • Siddiqi, Imran5
  • Gong, Jerald6
  • Lu, Chuanyi Mark7
  • Wang, Endi1
  • 1 Pathology, Duke University Medical Center, Durham, North Carolina, USA.
  • 2 Pathology, Duke University Medical Center, Durham, North Carolina, USA [email protected]
  • 3 Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China. , (China)
  • 4 Pathology, University of North Carolina, Chapel Hill, North Carolina, USA.
  • 5 Pathology, University of Southern California, Los Angeles, California, USA.
  • 6 Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
  • 7 Laboratory Medicine, University of California San Francisco, San Francisco, California, USA.
Type
Published Article
Journal
Journal of Clinical Pathology
Publisher
BMJ
Publication Date
May 01, 2022
Volume
75
Issue
5
Pages
292–301
Identifiers
DOI: 10.1136/jclinpath-2020-207334
PMID: 33542108
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Myeloid neoplasms occur in the setting of chronic lymphocytic leukaemia (CLL)/CLL-like disease. The underlying pathogenesis has not been elucidated. Retrospectively analysed 66 cases of myeloid neoplasms in patients with CLL/CLL-like disease. Of these, 33 patients (group 1) had received treatment for CLL/CLL-like disease, while the other 33 patients (group 2) had either concurrent diagnoses or untreated CLL/CLL-like disease before identifying myeloid neoplasms. The two categories had distinct features in clinical presentation, spectrum of myeloid neoplasm, morphology, cytogenetic profile and clinical outcome. Compared with group 2, group 1 demonstrated a younger age at the diagnosis of myeloid neoplasm (median, 65 vs 71 years), a higher fraction of myelodysplastic syndrome (64% vs 36%; OR: 3.1; p<0.05), a higher rate of adverse unbalanced cytogenetic abnormalities, including complex changes, -5/5q- and/or -7/7q- (83% vs 28%; OR: 13.1; p<0.001) and a shorter overall survival (median, 12 vs 44 months; p<0.05). Myeloid neoplasm in the setting of CLL/CLL-like disease can be divided into two categories, one with prior treatment for CLL/CLL-like disease and the other without. CLL-type treatment may accelerate myeloid leukaemogenesis. The risk is estimated to be 13-fold higher in patients with treatment than those without. The causative agent could be attributed to fludarabine in combination with alkylators, based on the latency of myeloid leukaemogenesis and the cytogenetic profile. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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