Can you have two blood cancers?

[Redkatt]

Might be a silly question to ask but can you have two blood cancers? Eg. CLL and MZL?

[Skyshark]

Unfortunately yes.

Just as it is possible to have a "de novo" case of DLBCL with CLL, which isn't Richter's syndrome (RS).

Clonally unrelated cases are genetically and immunologically distinct from clonally related DLBCL-RS, have more favorable responses to CIT, and are best treated as de novo DLBCL

ashpublications.org/hematol...

[Redkatt in reply to Skyshark]

New to this diagnosis so could you explain DLBCL and Richter’s syndrome

[Skyshark in reply to Redkatt]

DLBCL is Diffuse Large B-Cell Lymphoma. It can arise by itself and without CLL, then it's called "de novo". Or a single CLL cell can transform to DLBCL, this is called Richter's syndrome.

DLBCL develops faster and treatment is required urgently.

Unmutated IgHV, NOTCH1 and bulky disease are all associated with an increased risk.

Section 6.

nccn.org/patients/guideline...

[Blue-bird_ in reply to Redkatt]

You'll want to do some googleing because there will be a lot of new terms thrown at you and the doctors don't really have time to break them all down.

Blood cancer will either affect your T cells or B cells. B cell cancers typically respond better to treatment, but there are many variables to consider. DLBCL stands for diffuse large b cell lymphoma, which is a type of fast growing non-hodgkins lymphoma. Your doctor may or may not give you the specifics of your cancer. I had to go digging to find out what type my husband had.

My husband was diagnosed with DLBCL Central Nervous System lymphoma, mainly in his lobes, not as far down as his spinal cord. He also had/has CLL affecting his B cells, but they were unrelated, although having one cancer makes you more likely to develop a second, due to prolonged inflammation. If you had untreated CLL, it could have led to you developing a second cancer, hence the MZL diagnosis.

It doesn't necessarily matter how many cancers you have, what matters is whether they respond to treatment. Your doctor will typically treat the more aggressive, or faster growing, cancer first. However, my husband started treatment for CLL because his lymphoma couldn't be biopsied while his blood counts were suppressed by the leukemia.

It may be useful to look up treatment protocols for your cancers. When reading statistics, remember that they are only accounts of what has happened in the past and are not predictive of your outcome. And the figures are a relatively narrow interpretation of the illness; they exclude a lot of demographics and variables to allow for evidence based comparisons, but you won't necessarily fit into any of those categories. Existing health conditions, age, disease progression, genetic markers and other factors all make a difference.

In my husband's case, he had 100% disease infiltration with his CLL and he had several lesions in his brain, leading to impaired neurological function and weakness in a number of areas of his body. But he responded well to treatment and has been in remission for almost 2 years now.

I was/am his caregiver and had to do a lot of research on my own so I knew what questions to ask and treatments to request. I recommend doing your own research and asking questions on this forum if you feel up to it. If you are in the UK, I would also get in touch with macmillan, they are a charity who offer very comprehensive advice for people diagnosed with cancer, their caregivers and relatives.

[Redkatt in reply to Blue-bird_]

Thank you for that advice. So much to learn! Best wishes to you and your husband

[bennevisplace]

In principle you can have CLL alongside any other kind of cancer aka second primary malignancy (SPM). This major study in the Netherlands looked at the relative risk CLL patients had, compared to the general population, of developing SPMs of various kinds, including the blood cancers non-Hodgkin's lymphoma (NHL), multiple myeloma (MM) and acute myeloid leukaemia (AML) nature.com/articles/s41408-...

Figure 4 of that article is especially instructive, because the chart shows the relative risk of these blood cancers developing in both untreated and treated CLL patients. The markedly increased risk of AML and MDS in treated patients may be explained by the widespread use of chemotherapeutic agents in the study population.

[Redkatt in reply to bennevisplace]

Thanks for the explanation of SPM. So many terms to get my head around!

[Jm954 Administrator]

Yes, you can have two different blood cancers as you suggest (CLL & MZL). Both are B cell lymphomas and it would be extremely rare.

There is at least one member here that has both CLL and chronic myeloid leukaemia (CML) and doing really well.

[Name-1 in reply to Jm954]

My first Dg was CLL/SLL (BMB result ), After byopsy lymph node axillae,new Dg iz MZL nodal/extranodal. Maybe is composite NHL? Fisch: Trisomy 12 before therapy.

[Redkatt in reply to Name-1]

First diagnosis CLL. After spleen biopsy new Dg is MZL. Rituximab treatment once weekly for four weeks. Haven’t had Fisch testing

[Name-1 in reply to Redkatt]

First therapy Chl- ex afterIII cycle-progression. Rituximab +Chl 6 cycles 2016/17 and 2020/21. PR. I have many problems with GI- nobody interesting.

[Redkatt in reply to Jm954]

At this point in time diagnosis is CLL and MZL. Further testing needed to see if it’s SMZL rather than MZL

[Redkatt in reply to Jm954]

At this point in time diagnosis is CLL and MZL. Further testing needed to see if it’s SMZL rather than MZL

[Jm954 Administrator in reply to Redkatt]

The circulating SMZL are very distinctive and different to CLL cells. They have small projections from the cells whereas CLL cells are smooth. They should be easily differentiated from the CLL population.

Good news is that both are indolent lymphomas with long life expectancy

Jackie

[Redkatt in reply to Jm954]

That is good news. Thanks for explaining the clear difference in CLL and SMZL cells.

[Skyshark]

It's also possible to have two or more clonally unrelated populations of CLL at the same time.

[Redkatt in reply to Skyshark]

So two different types of CLL?

[Jm954 Administrator in reply to Redkatt]

Yes, watermark.silverchair.com/a...

[Redkatt in reply to Jm954]

I don’t think the link is working

[Jm954 Administrator in reply to Redkatt]

Not working for me either now

Reference is as follows, you'll need to Google it.

Am J Clin Pathol 2006;126:23-28

Molecular Characterization of Chronic Lymphocytic Leukemia With Two Distinct Cell Populations

Evidence for Separate Clonal Origins by Hong Chang, PhD, MD, FRCPC, and Jan Cerny, MD

[Redkatt in reply to Jm954]

I get a message that the session has timed out

[wakewatcher]

it certainly is possible unfortunately. I have CLL and HCL (hairy cell leukaemia) and I am told that my I and V treatment should treat both.

[Redkatt in reply to wakewatcher]

We’re you diagnosed with both at the same time?

[wakewatcher in reply to Redkatt]

Ive had HCL for about 20 years and had 2 treatments of cladribine for it. I was doing really well at keeping it in remission for 10-12 years until my counts started dipping again but this time it was diagnosed as CLL being the main cause (I think from blood cytometry and then a bone marrow biopsy). So not diagnosed at the same time.

[Lambo1]

Absolutely. I have two - CLL (still in W&W) and an MPN (essential thrombothycemia)

[mrgreentea]

Yet another of us: My Mayo doc said that I have three: CLL, WM, and SMZL. Started treatment with Z immediately after initial extended 5-month dx (just started it 3 weeks ago). I had very few outward symptoms (e.g., one slightly enlarged armpit lymph node). Slightly enlarged spleen (14cm).

[Redkatt in reply to mrgreentea]

Not many outward symptoms here either just very enlarged spleen (20cm).

[Stuff427]

Unfortunately the answer is yes having WM and CLL for over a decade it is possible. As you can see it isn't as rare as you may think. The positive outcome in my case is that the same therapy works for both conditions. Acalabrutinub

[Redkatt in reply to Stuff427]

It certainly is more common than I thought.