Chronic myeloid leukemia as a secondary malignancy after ALK-positive anaplastic large cell lymphoma

Hum Pathol. 2007 Oct;38(10):1576-80. doi: 10.1016/j.humpath.2007.05.018.

Abstract

The development of Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in the adolescent population is very rare. CML occurring as a secondary malignancy in individuals treated for anaplastic large cell lymphoma (ALCL) is also rare. We present the case of a 16-year-old adolescent boy who developed a right orbital mass that was diagnosed as ALCL with the t(2;5)(p23;q25) chromosomal aberration. Four years after receiving treatment for ALCL, he presented with a swollen leg and a white cell count of 431,000. Peripheral blood and bone marrow evaluation revealed a myeloproliferative disorder. Cytogenetic and molecular studies demonstrated the presence of t(9;22). We present the histopathologic, molecular, and cytogenetic findings of this patient's initial presentation with systemic ALCL as well as his secondary presentation with CML 4 years later. Therapy-related CML and non-therapy-related secondary CML are discussed as potential explanations of this highly unusual clinical presentation.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anaplastic Lymphoma Kinase
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bone Marrow Transplantation
  • Cyclophosphamide / therapeutic use
  • Daunorubicin / therapeutic use
  • Flow Cytometry
  • Fusion Proteins, bcr-abl / genetics
  • Humans
  • In Situ Hybridization, Fluorescence
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / genetics
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / metabolism
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Male
  • Neoplasms, Second Primary / genetics
  • Neoplasms, Second Primary / pathology*
  • Neoplasms, Second Primary / therapy
  • Orbital Neoplasms / pathology
  • Protein-Tyrosine Kinases / metabolism*
  • Receptor Protein-Tyrosine Kinases
  • Reverse Transcriptase Polymerase Chain Reaction
  • Vincristine / therapeutic use

Substances

  • Vincristine
  • Cyclophosphamide
  • ALK protein, human
  • Anaplastic Lymphoma Kinase
  • Protein-Tyrosine Kinases
  • Receptor Protein-Tyrosine Kinases
  • Fusion Proteins, bcr-abl
  • Daunorubicin