International Journal of Hematology

, Volume 91, Issue 3, pp 516–521

Emergence of chronic myelogenous leukemia during treatment for essential thrombocythemia

  • Shinsuke Mizutani
  • Junya Kuroda
  • Daisuke Shimizu
  • Shigeo Horiike
  • Masafumi Taniwaki
Case Report


A 72-year-old male patient was initially diagnosed with essential thrombocythemia (ET), a Philadelphia chromosome-negative (Ph1) chronic myeloproliferative disorder (CMPD), and was treated with hydroxyurea (HU). After 9 years of diagnosis of ET, his peripheral leukocytes gradually increased, while his platelet count showed a decrease. Bone marrow analysis disclosed Ph-positive chronic myelogenous leukemia (CML) in the chronic phase. Administration of imatinib mesylate (IM), a Bcr–Abl tyrosine kinase inhibitor (TKI), induced complete hematologic response in a month, but was discontinued after 4 months because of Grade 3 pleural effusion (PE). The treatment was switched to nilotinib which successfully induced a complete cytogenetic response (CCyR) after 5 months of TKI therapy and resolved the PE. Despite CCyR, however, ET recurred. Since then, the patient has been treated for 8 months with a combination of nilotinib and HU which has successfully controlled both CML and ET. This report includes a review of the characteristics of 15 reported cases with co-occurrence of CML and Bcr–Abl-negative CMPDs, including ours. Although rare, care needs to be taken since, despite the often similar clinical features of the two diseases, they require completely different treatments.


Chronic myelogenous leukemia Essential thrombocythemia Chronic myeloproliferative disorder Tyrosine kinase inhibitor 


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Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Shinsuke Mizutani
    • 1
  • Junya Kuroda
    • 1
  • Daisuke Shimizu
    • 1
    • 2
  • Shigeo Horiike
    • 1
  • Masafumi Taniwaki
    • 1
  1. 1.Division of Hematology and Oncology, Department of MedicineKyoto Prefectural University of MedicineKyotoJapan
  2. 2.Department of MedicineFukuchiyama City HospitalKyotoJapan

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