Are CLL Patients At-Risk for AML or CML?

Our recent CLL Global Research Foundation virtual town hall featured CLL Global President, Dr. William Wierda, and Dr. Patrick Reville, Assistant Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. CLL patient advocate Jeff Folloder moderated the event. Watch the full webinar.

Transcript

Jeff Folloder:

Dr. Reville, we have a question that came in that I haven’t heard before. “Is there a risk of CML or AML from CLL, and what about from CLL therapies?” And before you answer, tell us what CML and AML are.

Dr. Patrick Reville:

Right. So, CML and AML are two other types of leukemia. So, CML is chronic myeloid or chronic myelogenous leukemia. It’s sort of in some ways analogous to CLL, just in a different immune cell. So, CLL happens in the B lymphocytes, and CML happens in myeloid cells. So, it’s a chronic leukemia of myeloid cells.

AML is an acute leukemia, so a quicker moving, more aggressive leukemia of myeloid cells.

In terms of the risk for CLL to CML, there is none that I am aware of in terms of risk of CLL to CML. In terms of AML, I’d say that there is no direct risk from the CLL per se, meaning that going back to the sort of genetic question, I think the genetics of CLL and AML are very different.

But AML, acute myeloid leukemia, can occur in some patients that have received chemotherapy in the past. And so any chemotherapy agent, or certain chemotherapy agents do carry a risk of causing damage to the bone marrow, and then damage to the bone marrow can result in AML.

Those risks sort of vary study to study and regimen to regimen, but are generally low. But maybe somewhere in the 1 to 5 percent risk for the various types of regimens.

So, there are patients with CLL that would have gotten chemotherapy or chemoimmunotherapy for the CLL, or allotransplants in which part of the transplant preparative regimen was chemotherapy, and that can injure the bone marrow in a way that can cause a secondary leukemia, and sometimes that secondary leukemia is AML.

So, in that way you can have this link between CLL and AML, but it’s usually through the chemotherapy component.