Chronic Myelogenous Leukemia in a 66-Year-Old Male with Concurrent Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Patient: A 66-year-old Caucasian male.Chief Complaint: The patient felt tired and was eating less than usual. Previously, the patient could ride his bike for 3 miles, but now can barely complete 1 mile.Medical History: Significant for persistent lymphocytosis for the past 10 years and recently diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) by flow cytometry on peripheral blood. He also has a history of hyperlipidemia, diabetes mellitus, and obstructive sleep apnea.Social History: The patient does not smoke or use illicit drugs. He uses alcohol occasionally. The patient is married and is retired from an automobile supply company.Family History: Noncontributory. None of his family members have a history of blood disorders.Physical Examination: Significant for the following: alert; oriented to time, place, and person; neck: no palpable lymphadenopathy; heart and lung: unremarkable; abdomen: obese and soft, no palpable hepatosplenomegaly.Vital signs: Blood pressure: 137/58 mmHg; pulse: 68/minute; respiratory rate: 12/minute; temperature: 37°C.Principal Laboratory Findings: Laboratory test results are in Table 1.Additional Testing: The molecular diagnostic test Janus kinase 2 ( JAK2 ) V617F mutation was ordered. A peripheral blood smear at the hematologist’s office was abnormal 3 months later. Subsequently, on the peripheral blood specimen the molecular test assessing presence of BCR/ABL1 mRNA transcript producing the 210-kDa protein (p210) was ordered and a bone marrow biopsy with aspirate was performed. The bone marrow aspirate was also submitted for morphologic, cytogenetic, and flow cytometric evaluations (Images 1 and 2).1. What are the most significant clinical and laboratory findings in this patient?2. What are the differential diagnoses and the most likely diagnosis?3. What is the clinical presentation of this entity?4. How is the disease diagnosed with the aid of clinical laboratory tests, a peripheral blood smear, and bone marrow exam?5. How is the entity managed and …