Chronic lymphocytic leukemia followed by myelodysplastic syndrome and erythroleukemia

CLL patients are more exposed to develop a second neoplasm, but the association. CLL-MDS is an unusual one. We present the case of a 61-year-old male patient, diagnosed with chronic lymphocytic leukemia in 2007, who developed myelodysplastic features three years later and then acute myeloid leukemia. At diagnosis, the blood tests showed leucocytosis, with lymphocytosis in the peripheral blood and bone marrow. Due to the negative prognostic factors, the patient received treatment with an alkylating agent (FC protocol) and then with alemtuzumab. Three years after being diagnosed with CLL, the patient presented with malaise, recent faintness and fever, with severe anemia and thrombocytopenia. The results from the bone marrow aspirate and biopsy established a new diagnosis: myelodysplastic syndrome. The patient's general condition was rapidly deteriorating and just two months later, he evolved into acute myeloid leukemia, subtype 6, a very rare type of AML. Soon after, neurological alterations led to cerebral hemorrhage and death. A review of literature is also presented.