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Simultaneous chronic lymphocytic leukemia and chronic myelogenous leukemia. Evidence of a separate stem cell origin

The authors studied a patient with the simultaneous occurrence of chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML). The coexistence of these two hematologic malignancies leads to questions about their cell of origin. Through analysis of this patient's DNA, the authors studied the derivation of the two malignancies. They separated the blood into a myeloidrich fraction and a fraction containing the malignant lymphocytes. JH and bcr probes were used to study these loci in the myeloid and lymphoid fractions and in unfractionated white blood cells. The authors found that the unfractionated leukocytes contained the bcr and JH rearrangements. Conversely, the lymphoid fraction contained only the JH rearrangement, and the myeloid fraction contained only the bcr rearrangement, suggesting that these malignancies arose from separate stem cells. This is the first reported patient with simultaneously occurring CML and CLL definitively shown to arise from distinct progenitors, and this report raises questions about the origin of these two cell lines.