Sequential Development of Chronic Lymphocytic Leukemia (CLL) in a Chronic Myeloid Leukemia (CML) Patient Treated With Nilotinib: A Case Report
Year: 2025
Type: article
Study design: Case Report
Abstract: Chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL) are distinct clonal hematologic malignancies that rarely occur in the same patient. We report the case of a 52-year-old male with CML who achieved a sustained major molecular response on the tyrosine kinase inhibitor (TKI) nilotinib and who subsequently developed asymptomatic CLL during follow-up. The CML was well-controlled (BCR-ABL1 < 0.1%), and leukocytosis was investigated and found to be due to a monoclonal B-cell population consistent with CLL. This unusual sequential presentation highlights the importance of evaluating unexplained leukocytosis even in a patient with well-managed CML. We discuss potential pathophysiologic mechanisms, including whether TKI therapy could influence clonal evolution and review relevant literature. The patient continues nilotinib therapy with ongoing CML remission and remains under observation for CLL, underscoring a conservative management approach given the indolent nature of his CLL. This case adds to the sparse literature on CML and CLL co-occurrence and raises awareness of secondary hematologic malignancies in TKI-treated CML patients.
Source: Cureus
DOI: 10.7759/cureus.91223
Authors: Ahmed Elazab, Maged Saafan, Noreen Elbayoumi
Institution: Mansoura University
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413807600