Hattori Hideki, Kuwayama Maki, Kotake Takeshi, Karasuno Takahiro
Dept. of Internal Medicine, Yao Municipal Hospital.
Gan To Kagaku Ryoho. 2011 Feb;38(2):333-6.
Since the progression of chronic lymphocytic leukemia(CLL)is long and requires lengthy primary disease management, the risk of double primary cancers and secondary cancer due to treatment has become an issue in western countries with a high incidence of CLL. However, the coexistence with chronic myeloid leukemia(CML)is rare even in the West, and no cases have been reported in Japan. At this time, we would like to report a rare case of CML coexisting during the progression of CLL. The patient was a 68-year-old woman. As she had entered the advanced stage of B-cell chronic lymphocytic leukemia(B-CLL), fludarabine, a purine analog agent, was administered. Two years later, a high-granulocyte dominant white blood cell count began to appear. BCR/ABL analysis by FISH was 97. 6%positive, and the chromosomal test was t(9:22)(q34:q11), so CML was diagnosed. Coexistence of CML in CLL can mainly be classified into three types; CML preceding CLL, CLL preceding CML, and simultaneous occurrence, and the most common, as in this case, long progression CLL preceding CML. At this time, we performed a mainly bibliographical consideration according to the main occurrence type, including the possibility of secondary CML due to fludarabine.
由于慢性淋巴细胞白血病（CLL）病程漫长，需要长期进行原发性疾病管理，在CLL发病率较高的西方国家，因治疗导致的双原发性癌症和继发性癌症风险已成为一个问题。然而，即使在西方，慢性粒细胞白血病（CML）与之共存的情况也很罕见，日本尚无相关病例报道。此时，我们报告一例在CLL病程中并发CML的罕见病例。患者为一名68岁女性。由于她已进入B细胞慢性淋巴细胞白血病（B-CLL）晚期，给予了嘌呤类似物氟达拉滨治疗。两年后，开始出现以粒细胞为主的高白细胞计数。荧光原位杂交（FISH）检测BCR/ABL分析结果为97.6%阳性，染色体检测为t（9:22）（q34:q11），因此诊断为CML。CLL中CML的共存主要可分为三种类型：CML先于CLL、CLL先于CML以及同时发生，而最常见的情况，如本病例，是病程较长的CLL先于CML。此时，我们根据主要发生类型进行了主要基于文献的分析，包括氟达拉滨导致继发性CML的可能性。
