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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

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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
  1. Catherine Luedke1,
  2. Yue Zhao1,2,
  3. Jenna McCracken1,
  4. Jake Maule1,
  5. Lian-He Yang1,2,
  6. Rachel Jug1,
  7. Jonathan Galeotti3,
  8. Imran Siddiqi4,
  9. Jerald Gong5,
  10. Chuanyi Mark Lu6,
  11. Endi Wang1
  1. 1 Pathology, Duke University Medical Center, Durham, North Carolina, USA
  2. 2 Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
  3. 3 Pathology, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4 Pathology, University of Southern California, Los Angeles, California, USA
  5. 5 Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  6. 6 Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Yue Zhao, Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China; zhaoyue{at}cmu.edu.cn

Abstract

Aims Myeloid neoplasms occur in the setting of chronic lymphocytic leukaemia (CLL)/CLL-like disease. The underlying pathogenesis has not been elucidated.

Methods Retrospectively analysed 66 cases of myeloid neoplasms in patients with CLL/CLL-like disease.

Results 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).

Conclusions 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.

  • myelodysplastic syndromes
  • myeloproliferative disorders
  • leukemia
  • myeloid

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/jclinpath-2020-207334

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Handling editor Mary Frances McMullin.

    • Contributors CL wrote the original draft. YZ prepared the figures, analysed the data and edited the manuscript. JMcC and JM edited the manuscript. L-HY, RJ, JG, IS, JG and CML collected the data. EW organised the study and wrote the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.