Efficacy of venetoclax and rituximab in the treatment of concurrent acute myeloid leukemia and untreated chronic lymphocytic leukemia: A case report and literature review

Chen,Yafang; Yuan,Linyu; Lu,Xinxiao; Wang,Xue; Zhang,Qiuqiu; Wang,Xiaofang; Zhao,Xingli

doi:10.3892/ol.2024.14526

Efficacy of venetoclax and rituximab in the treatment of concurrent acute myeloid leukemia and untreated chronic lymphocytic leukemia: A case report and literature review

Authors:
- Yafang Chen
- Linyu Yuan
- Xinxiao Lu
- Xue Wang
- Qiuqiu Zhang
- Xiaofang Wang
- Xingli Zhao
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Affiliations: Department of Hematology, Oncology Center, Tianjin Union Medical Center of Nankai University, Tianjin 300121, P.R. China, Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
Published online on: June 25, 2024 https://doi.org/10.3892/ol.2024.14526
Article Number: 393
Copyright: © Chen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

To date, few cases of concurrent acute myeloid leukemia (AML) and untreated chronic lymphocytic leukemia (CLL) have been reported. Due to the complexity of the pathogenesis and the absence of a uniform treatment regimen, the associated prognosis remains poor. The present study reports the case of a 58‑year‑old male with asymptomatic leukocytosis, who was previously healthy with no malignancies. Flow cytometry analysis revealed protocytosis, monocytosis and monoclonal B lymphocytosis in a bone marrow specimen. Results of a gene rearrangement assay demonstrated positive immunoglobulin heavy‑chain variable region gene status in monoclonal B lymphocytes. Thus, the patient was diagnosed with AML with maturation (AML‑M2) that co‑existed with untreated CLL. The normative daunorubicin (40 mg/m² on days 1‑3) and cytarabine (80 mg/m² on days 1‑7) regimen combined with venetoclax (400 mg on days 1‑7) and rituximab (375 mg/m² on day 0) was used as induction chemotherapy. The patient achieved morphological complete remission in both AML and CLL following the first course of chemotherapy. In addition, the present study retrospectively analyzed the data of 22 patients with concurrent AML and untreated CLL, and the results demonstrated that the median age at the time of AML diagnosis was 69 years (range, 52‑86 years). Moreover, the male:female ratio was 6.33:1 and AML‑M2 was the most frequent subtype at diagnosis. The presence of a complex karyotype was associated with the poorest prognosis, and patients who received venetoclax often exhibited an improved prognosis. In conclusion, the combination of venetoclax and rituximab improves the prognosis of patients with concurrent AML and untreated CLL.

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