Chronic myelogenous leukemia following small lymphocytic lymphoma: a case report and review of literature.

Chronic myelogenous leukemia (CML) following non-Hodgkin's lymphoma (NHL) is extremely rare. Here we report a unique case of CML after small lymphocytic lymphoma (SLL). A 64-years-old Asian female was firstly diagnosed as SLL by biopsies of the retroperitoneal and the mesenteric root lymph nodes, with bone marrow (BM) involvement. BM chromosome showed no abnormalities, and the rearrangement of () and () gene were present. After treatment with three courses of fludarabine, cyclophosphamide, and rituximab (FCR) regimens, the patient achieved complete response. However, she progressed to CML 35 months later, with Philadelphia translocation and the major fusion transcript (p210), and she has a good prognosis with imatinib. It is not clear whether gene was present at the time of primary diagnosis for SLL, so we extracted genomic DNA from the patient's paraffin-embedded BM biopsies at the first diagnosis of SLL for comparison, but real-time quantitative PCR assay for gene was negative. Taken together, there is a strong possibility that FCR therapy caused the gene rearrangement, and then became CML in 35 months.