Refractory anaemia terminating in a combined lymphoproliferative and myeloproliferative disorder.

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Abstract
A case of non-sideroblastic refractory anemia is reported which evolved to a double lymphomyeloproliferative disorder. At presentation, bone marrow appearances and peripheral blood pancytopenia without myelomonocytosis were consistent with a diagnosis of non-sideroblastic refractory anemia. Subsequently, the patient developed pronounced myelomonocytosis and lymphocytosis with prolymphocytes. Light and transmission electron microscopy and surface marker studies were compatible with a diagnosis of prolymphocytic transformation of chronic lymphocytic leukemia/prolymphocytic leukemia associated with myelomonocytic leukemia. The pathogenesis of such double lymphomyeloproliferative disorders is discussed in the light of the evidence for common lymphoid and myeloid progenitor cells and some recent advances in the immunology of the myelodysplastic syndromes.