Chronic lymphocytic leukemia with progressive anemia secondary to development of composite lymphoma

Prolymphocytic transformation of chronic lymphocytic leukemia is a rare but recognized entity. We present the case of a 76-year-old gentleman with a previous diagnosis of chronic lymphocytic leukemia who presented with fatigue, fever, and a white blood cell count of 500 000 with prolymphocytes on peripheral blood examination. Chlorambucil and dexamethasone were initiated. He developed progressive anemia during his admission with no clear cause on initial CT examination. Bilateral hip pain began several days later and he was unfortunately diagnosed with a large spontaneous retroperitoneal hemorrhage postmortem. This condition is rare and generally occurs in those receiving therapeutic anticoagulation or dialysis, with known bleeding disorders or vascular malformation, none of which were present in our patient. Pathology revealed marked leukemoid engorgement of the vessels of many organs with prolymphocytes. We discuss the potential etiologies and relationships between these critical diagnoses.

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Chronic Lymphocytic Leukemia with Divergent Richter’s Transformation into a Clonally Related Classical Hodgkin’s and Plasmablastic Lymphoma: A Case Report

Case Reports in Oncology ◽

10.1159/000505683 ◽

2020 ◽

Vol 13 (1) ◽

pp. 120-129 ◽

Cited By ~ 1

Author(s):

Gorana Gasljevic ◽

Mateja Grat ◽

Veronika Kloboves Prevodnik ◽

Biljana Grcar Kuzmanov ◽

Barbara Gazic ◽

...

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Lymphocytic Leukemia ◽

Plasmablastic Lymphoma ◽

Aggressive Lymphoma ◽

Composite Lymphoma ◽

Large B Cell Lymphoma ◽

Trisomy 12 ◽

Oncologic Treatment

Chronic lymphocytic leukemia (CLL) typically pursues a prolonged course. Its transformation into a more aggressive lymphoma occurs in 2–8% of all patients. Most commonly, diffuse large B-cell lymphoma develops. Transformation into a classical Hodgkin’s lymphoma (cHL) occurs in <1%. Plasmablastic transformation has been only rarely reported. Cases of synchronous divergent transformation of CLL into a composite lymphoma are exceedingly rare. We describe the unique occurrence of the transformation of a long-standing CLL into a synchronous clonally related cHL as well as plasmablastic lymphoma (PBL) in an 85-year-old female patient. After 10 years of asymptomatic CLL, our patient was treated with a rituximab-chlorambucil scheme in combination with pegfilgrastim for recurrent infections and the development of B symptoms. Five cycles (of six planned) were administrated with no adverse effects. After the fifth cycle, lymphadenopathy with pronounced B symptoms appeared. Histology showed the presence of cHL in the lymph node, while the bone marrow was infiltrated by PBL. Our patient died in sepsis not receiving further specific oncologic treatment due to her poor general condition. Additional cytogenetic and molecular studies showed that this was a case of mutated CLL with trisomies of chromosomes 12, 3, and 18 (a rare specific +12 plus other-non+19 CLL subgroup). The presence of trisomy 12 has also been proved in plasmablasts and in cHL cells.

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