AML-448: Overlapping B-Cell Non-Hodgkin Lymphoma with Myeloid Malignancies: A Case Series

Abstract

Context: This case series is reported from the cases we give care to in our facility. Objective: The main objective of this study is to highlight the possible co-incidence of myeloid malignancy with mature B cell neoplasm. Design: This is a case series. Patients or Other Participants: The case series included 4 patients with mature B-cell neoplasms and developed myeloid malignancy at the time of first presentation without giving any history of previous chemotherapy or radiotherapy exposure. Main Outcomes Measures: The main outcome is to report the possible occurrence of this confusing association and to study the biology behind it. Results: We have 4 cases included in this series. Case 1: A 58-year-old male who was diagnosed with chronic myeloid leukemia and showed accelerated profile. His CBC film showed peripheral leukocytosis, which was mistaken initially as a sign of acceleration; however the cell morphology was suspicious. Flow cytometric studies showed a mantle cells phenotype. His cytogenetics showed t(9,11) and extra Philadelphia chromosome. This patient received high-dose cytarabine with tyrosine kinase inhibitors and showed good response. Case 2: A 47-year-old female who was diagnosed with chronic lymphocytic leukemia (CLL) and put under watchful waiting. Then, she developed pancytopenia and appearance of aggressive B symptoms. Bone marrow examination and flow cytometry confirmed the presence of two clones of cells, one of CLL phenotype and the other of myelomonocytic line, and she had normal karyotyping. She received the FLAG protocol and went into remission. Case 3: A 32-year-old male presented with enlarged cervical LNs and peripheral leukocytosis. Excisional LN biopsy confirmed follicular NHL; however, promyelocytes were seen in his peripheral blood smear. Further PML-RARA mutation was detected with FISH, confirming the diagnosis of coinciding acute promyelocytic leukemia. Unfortunately, this patient died during chemotherapy induction from sepsis. Case 4: A 56-year-old male presented with bleeding and anemia. Bone marrow aspiration showed acute myeloid leukemia with dysplastic features. Further trephine biopsy showed a CLL clone. He received induction chemotherapy and died with sepsis. Conclusions: This overlap of hematologic malignancies may suggest that there is a common molecular aberration behind them. Testing for TP53 mutations should have been done together with germline mutations.