CLL-155: Differential Diagnosis of Aplastic Anaemia in Chronic Lymphocytic Leukaemia

Abstract

A 73-year-old lady presented in September of 2019 with pancytopenia on a background of 17p and 13q deleted chronic lymphocytic leukaemia (CLL) on ibrutinib. The diagnosis of CLL was made in 2008 and no treatment was required until she developed progressive cytopenias in January of 2019, with a lymphocyte count of 193.8 ×109/L. Fluorescence in-situ hybridisation (FISH) demonstrated 17p and 13q deletions and she was commenced on ibrutinib. She developed atrial fibrillation but otherwise tolerated the therapy well. She represented with significant fatigue and bleeding in September of 2019 and her blood count revealed a haemoglobin (Hb) of 8.2 g/dL, a platelet count of 6 ×109/L, a lymphocyte count of 32 ×109/L, a neutrophil count of 0.24 ×109/L and a reticulocyte count of References [1] Zonder JA, Keating M, Schiffer CA. Chronic Lymphocytic Leukemia presenting in association with Aplastic Anemia. Am. J. Hematol. 2002 71:323–327. [2] Castiglioni MG, Scatena P, Pandolfo C et al. Rituximab Therapy of Severe Aplastic Anemia Induced by Fludarabine and Cyclophosphamide in a Patient Affected by B-cell Chronic Lymphocytic Leukemia. 2006 Sep;47(9):1985-6. [3] Singal R, Winfield DA, Greaves M. Bone marrow aplasia in B cell chronic lymphocytic leukaemia: Successful treatment with antithymocyte globulin. J Clin Pathol 1991; 44:954-956. [4] Vitale C, Ahn IE, Sivina M et al. Autoimmune cytopenias in patients with chronic lymphocytic leukemia treated with ibrutinib. Haematologica 2016; 101:e257.