Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
3980996 | Clinical Leukemia | 2007 | 4 Pages |
The association of myelodysplastic syndromes with lymphoid malignancies has rarely been reported. To our knowledge, there are only 5 reported cases of chronic lymphocytic leukemia (CLL) and chronic myelomonocytic leukemia (CMML) occurring in the same patient. Herein, we describe the case of an 80-year-old woman diagnosed with CLL. She declined chemotherapy and began weekly rituximab 375 mg/m2 intravenously. She initially had a solid partial response to treatment. However, after 2 treatments with rituximab her white blood cell count increased, and a peripheral smear was remarkable for large, cleaved, folded cells, identified as monocytes. The previous bone marrow biopsy was retrieved and restained with an α-naphthol butyl esterase for monocytes. An increased atypical monocytic population was exposed, indicative of an evolving CMML. Her 2 malignancies probably arose from 2 different clones by chance. Treatment was begun with decitabine, but with no response. The patient remains transfusion dependent although relatively asymptomatic on hydroxyurea.