We present the case of a 71-year-old woman diagnosed with chronic lymphocytic leukemia who received multiple chemotherapeutic lines and evolved to acute lymphoblastic leukemia. The patient was Rai stage 0 at the time of the diagnosis and was monitored for almost 9 years. After that, the disease progressed and the patient began chemotherapy (fludarabine/cyclophosphamide combination), obtained complete remission and relapsed one year later after finishing treatment. She received multiple therapeutic regimens, accompanied by multiple infectious complications. After 8 years of evolution since she started chemotherapy, bone marrow aspirate and immunophenotyping revealed acute lymphoblastic leukemia. The occurrence of acute leukemia in CLL is rare and may arise from the same clone; however, most cases appear after patients have received chemotherapy, suggesting that they are therapy-related.
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1. DIEHL LF KARNELL LH MENCK HR. The National Cancer Data Base report on age gender treatment and outcomes of patients with chronic lymphocytic leukemia. Cancer 1999; 86:2684–2692.
2. SGAMBATI MT LINET MS DEVESA SS. Chronic lymphocytic leukemia: epidemiological familial and genetic aspects. In: Cheson BD ed. Chronic lymphoid leukemias 2nd ed. New York: Marcel Dekker 2001:33–62.
3. ZENT CS KYASA MJ EVANS R et al. Chronic lymphocytic leukemia incidence is substantially higher than estimated from tumor registry data. Cancer 2001; 92:1325–1330.
4. BINET JL AUQUIER A DIGIERO G et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981; 48:198-206.
5. KYASA MJ HAZLETT L PARRISH RS et al. Veterans with CLL/SLL have a markedly increased rate of second malignancy which is the most common cause of death. Leuk Lymphoma 2004; 45:507-513.
6. ROBAK T. Second malignancies and Richter syndrome in patients with chronic lymphocytic leukemia. Hematology 2004; 9:387–400.
7. ZARRABI MH GRUNWALK HW ROSNER F. Chronic lymphocytic leukemia terminating in acute leukemia. Arch Intern Med 1977; 137:1059–1064.
8. ROBERTSON LE ESTEY E KANTARJIAN H et al. Therapy related leukemia and myelodysplastic syndrome in chronic lymphocytic leukemia. Leukemia 1997; 8:2047–2051.
9. MORRISON VA RAI KR PETERSON BL et al. Therapy-related myeloid leukemias are observed in patients with chronic lymphocytic leukemia after treatment with fludarabine and chlorambucil: results of an intergroup study cancer and leukemia group B 9011. J Clin Oncol 2002; 20:3878–3884.
10. BENE MC CASTOLDI G ORFAO A et al. Proposal for the immunological classification of acute leukemias. Leukemia. 1995; 10:1783-6.
11. FLINN IW NEUBERG DS GRVER MR et al. Phase III trial of fludarabine and cyclophosphamide compared with fludarabine for patients with previously untreated chronic lymphocytic leukemia: US Intergroup Trial E2997. J Clin Oncol 2007; 25:793–798.