1
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Kutsch N, Gödel P, Voltin CA, Hallek M, Scheid C, Borchmann P, Holtick U. Long-term remission in a patient with relapsed Richter's transformation treated with CD19-directed chimeric antigen-receptor T-cells after allogeneic stem cell transplantation. Eur J Haematol 2024; 112:984-987. [PMID: 38316549 DOI: 10.1111/ejh.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
Patients with Richter's transformation of chronic lymphocytic leukemia (CLL) to diffuse large B-cell lymphoma (DLBCL-RT) face a dismal prognosis. A 51-year-old female patient diagnosed with CLL with deletion (17p) in 2009. CLL treatment included chemoimmunotherapy and targeted substances. DLBCL-RT was diagnosed in November 2016. After receiving an allogeneic hematopoietic stem cell transplantation, she relapsed in September 2019 and tisagenlecleucel was infused in December 2019. Cytokine release syndrome grade 2 was treated with two doses of tocilizumab and the patient was started on 140 mg ibrutinib in February 2020. Our patient remains in remission up to 4 years after CAR T-cell treatment.
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MESH Headings
- Humans
- Female
- Middle Aged
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Hematopoietic Stem Cell Transplantation
- Transplantation, Homologous
- Immunotherapy, Adoptive/methods
- Immunotherapy, Adoptive/adverse effects
- Remission Induction
- Antigens, CD19/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Treatment Outcome
- Receptors, Chimeric Antigen
- Recurrence
- Combined Modality Therapy
- Piperidines/therapeutic use
- Receptors, Antigen, T-Cell/genetics
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Affiliation(s)
- Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Gödel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Conrad-Amadeus Voltin
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christof Scheid
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German CLL Study Group, University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Barrett A, Appleby N, Dreau H, Fox CP, Munir T, Eyre TA. Richter's transformation: Transforming the clinical landscape. Blood Rev 2024; 64:101163. [PMID: 38097488 DOI: 10.1016/j.blre.2023.101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 03/12/2024]
Abstract
Richter transformation (RT) represents an aggressive histological transformation from chronic lymphocytic leukaemia, most often to a large B cell lymphoma. It is characterised by chemo-resistance and subsequent short survival. Drug development has struggled over recent years in light of the aggressive kinetics of the disease, lack of pivotal registrational trials and relative rarity of the phenomenon. In this review we will highlight the diagnostic and therapeutic challenges of managing patients with RT as well as taking a look to the future therapeutic landscape. Highly active therapies developed across B cell malignancies are starting to impact this field, with T-cell activation therapies (CAR-T, bispecific antibodies), antibody-drug conjugates, and novel small molecule inhibitor combinations (e.g. BTKi-BCL2i) being actively studied. We will highlight the data supporting these developments and look to the studies to come to provide hope for patients suffering from this devastating disease.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/therapy
- Cell Transformation, Neoplastic
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Affiliation(s)
- A Barrett
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - N Appleby
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - H Dreau
- Oxford Molecular Diagnostic Centre, Oxford, United Kingdom
| | - C P Fox
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - T Munir
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - T A Eyre
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
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3
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Abrisqueta P, Nadeu F, Bosch-Schips J, Iacoboni G, Serna A, Cabirta A, Yáñez L, Quintanilla-Martínez L, Bosch F. From genetics to therapy: Unraveling the complexities of Richter transformation in chronic lymphocytic leukemia. Cancer Treat Rev 2023; 120:102619. [PMID: 37660626 DOI: 10.1016/j.ctrv.2023.102619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
Richter transformation (RT) refers to the progression of chronic lymphocytic leukemia, the most prevalent leukemia among adults, into a highly aggressive lymphoproliferative disorder, primarily a diffuse large B-cell lymphoma. This is a severe complication that continues to be a therapeutic challenge and remains an unmet medical need. Over the last five years, significant advances have occurred in uncovering the biological processes leading to the RT, refining criteria for properly diagnose RT from other entities, and exploring new therapeutic options beyond the ineffective chemotherapy. This review summarizes current knowledge in RT, including recent advances in the understanding of the pathogenesis of RT, in the classification of RT, and in the development of novel therapeutic strategies for this grave complication.
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Affiliation(s)
- Pau Abrisqueta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Jan Bosch-Schips
- Department of Pathology, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Angel Serna
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Lucrecia Yáñez
- Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Leticia Quintanilla-Martínez
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
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4
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Koshiishi M, Odate T, Nakagawa Y, Suzuki J, Kumagai T, Kawashima I, Yamamoto T, Nakajima K, Tanaka M, Oishi N, Kondo T, Kirito K. Early Transformation to Classic Hodgkin Lymphoma in a Chemotherapy-naïve Chronic Lymphocytic Leukemia Patient upon Initial Treatment with Ibrutinib. Intern Med 2021; 60:3305-3308. [PMID: 33896865 PMCID: PMC8580765 DOI: 10.2169/internalmedicine.6979-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old woman with a four-year history of chronic lymphocytic leukemia (CLL) received ibrutinib as initial treatment due to progressive anemia and thrombocytopenia. Eleven months after the start of the treatments, although her cytopenia had ameliorated, she developed classic Hodgkin lymphoma, a rare form of Richter's transformation. She was successfully treated with two courses of adriamycin, vinblastin, bleomycin and dacarbazine followed by radiotherapy. In general, several clinical, genetic and molecular factors are associated with Richter's transformation. In addition, our present case suggested that ibrutinib could be a potential risk factor for Richter's transformation in CLL patients.
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Affiliation(s)
- Megumi Koshiishi
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Toru Odate
- Department of Pathology, University of Yamanashi, Japan
| | - Yukie Nakagawa
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Jun Suzuki
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Takuya Kumagai
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Ichiro Kawashima
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Takeo Yamamoto
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Kei Nakajima
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Masaru Tanaka
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Japan
| | - Tetuso Kondo
- Department of Pathology, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology/Oncology, University of Yamanashi, Japan
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5
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Dimou M, Bitsani A, Roumelioti M, Dimitrakopoulou A, Iliakis T, Pardalis V, Grafakos I, Kalyva S, Markopoulos A, Kyrtsonis M, Panayiotidis P. Richter's transformation as leptomeningeal infiltration in a chronic lymphocytic leukemia patient receiving venetoclax. Could blood-brain barrier be a disease "sanctuary" during venetoclax treatment? Clin Case Rep 2021; 9:2249-2253. [PMID: 33936674 PMCID: PMC8077271 DOI: 10.1002/ccr3.4002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Our unique case of Richter's Transformation presenting as leptomeningial infiltration in a CLL patient receiving venetoclax raises questions on whether the drug penetrates the blood-brain barrier and at what extend, especially in reduced doses given for drug-drug interactions.
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Affiliation(s)
- Maria Dimou
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Aikaterini Bitsani
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Maria Roumelioti
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Aglaia Dimitrakopoulou
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Theodore Iliakis
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Vasileios Pardalis
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Ioannis Grafakos
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Sotiria Kalyva
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Athanasios Markopoulos
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Marie‐Christine Kyrtsonis
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
| | - Panayiotis Panayiotidis
- 1 Propedeutic Internal Medicine ClinicHematology Department and Molecular Laboratory in HematologyNational and Kapodistrian University of AthensAthensGreece
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6
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Petrackova A, Turcsanyi P, Papajik T, Kriegova E. Revisiting Richter transformation in the era of novel CLL agents. Blood Rev 2021; 49:100824. [PMID: 33775465 DOI: 10.1016/j.blre.2021.100824] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/14/2021] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
Richter transformation (RT) is the development of aggressive lymphoma - most frequently diffuse large B-cell lymphoma (DLBCL) and rarely Hodgkin lymphoma (HL) - arising on the background of chronic lymphocytic leukaemia (CLL). Despite recent advances in CLL treatment, RT also develops in patients on novel agents, usually occurring as an early event. RT incidence is lower in CLL patients treated with novel agents in the front line compared to relapsed/refractory cases, with a higher incidence in patients with TP53 disruption. The genetic heterogeneity and complexity are higher in RT-DLBCL than CLL; the genetics of RT-HL are largely unknown. In addition to TP53, aberrations in CDKN2A, MYC, and NOTCH1 are common in RT-DLBCL; however, no distinct RT-specific genetic aberration is recognised yet. RT-DLBCL on ibrutinib is frequently associated with BTK and PLCG2 mutations. Here, we update on genetic analysis, diagnostics and treatment options in RT in the era of novel agents.
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Affiliation(s)
- Anna Petrackova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Peter Turcsanyi
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Tomas Papajik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
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7
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Märklin M, Fuchs AR, Tandler C, Heitmann JS, Salih HR, Kauer J, Quintanilla-Martinez L, Wirths S, Kopp HG, Müller MR. Genetic Loss of LCK Kinase Leads to Acceleration of Chronic Lymphocytic Leukemia. Front Immunol 2020; 11:1995. [PMID: 32983140 PMCID: PMC7492521 DOI: 10.3389/fimmu.2020.01995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Most patients with chronic lymphocytic leukemia (CLL) exhibit an indolent disease course and unresponsive B cell receptors (BCRs) exemplified by an anergic phenotype of their leukemic cells. In up to 5% of patients, CLL transforms from an indolent subtype to an aggressive form of B cell lymphoma (Richter's syndrome), which is associated with worse disease outcome and severe downregulation of NFAT2. Here we show that ablation of the tyrosine kinase LCK, which has previously been characterized as a main NFAT2 target gene in CLL, leads to loss of the anergic phenotype, thereby restoring BCR signaling, which results in an acceleration of CLL. Our study identifies LCK as a main player in mediating BCR unresponsiveness and its role as a crucial regulator of anergy in CLL.
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Affiliation(s)
- Melanie Märklin
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.,Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), University Hospital Tübingen, Tübingen, Germany
| | - Alexander R Fuchs
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany
| | - Claudia Tandler
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), University Hospital Tübingen, Tübingen, Germany
| | - Jonas S Heitmann
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.,Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), University Hospital Tübingen, Tübingen, Germany
| | - Helmut R Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK), University Hospital Tübingen, Tübingen, Germany
| | - Joseph Kauer
- Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany
| | | | - Stefan Wirths
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany
| | - Hans-Georg Kopp
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.,Department of Molecular Oncology and Thoracic Oncology, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Martin R Müller
- Department of Hematology, Oncology and Clinical Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.,Department of Hematology, Oncology and Immunology, Klinikum Region Hannover, KRH Klinikum Siloah, Hanover, Germany
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8
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Gasljevic G, Grat M, Kloboves Prevodnik V, Grcar Kuzmanov B, Gazic B, Lovrecic L, Podgornik H. Chronic Lymphocytic Leukemia with Divergent Richter's Transformation into a Clonally Related Classical Hodgkin's and Plasmablastic Lymphoma: A Case Report. Case Rep Oncol 2020; 13:120-129. [PMID: 32231533 DOI: 10.1159/000505683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Gorana Gasljevic
- Department of Pathology, Institute of Oncology, Ljubljana, Slovenia
| | - Mateja Grat
- Department of Hematology, General Hospital Celje, Celje, Slovenia
| | | | | | - Barbara Gazic
- Department of Pathology, Institute of Oncology, Ljubljana, Slovenia
| | - Luca Lovrecic
- Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Helena Podgornik
- Department of Hematology, University Medical Center Ljubljana, Ljubljana, Slovenia
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9
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Sood A, Parihar AS, Lad D, Kumar R, Singh H, Mittal BR. An Unusual Presentation of Richter's Transformation of Chronic Lymphocytic Leukemia in Liver and Lung on 18F-Labeled Fluoro-2-Deoxyglucose Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2020; 35:70-71. [PMID: 31949376 PMCID: PMC6958950 DOI: 10.4103/ijnm.ijnm_175_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Richter's transformation (RT) is a rare complication of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) with unfavorable prognosis. The clinical and laboratory findings of RT are nonspecific and requires histopathological confirmation for the diagnosis. 18F-labeled fluoro-2-deoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) has shown higher diagnostic values for the detection of transformation of CLL/SLL to aggressive lymphoma. We present a case of CLL in remission for 6 years presenting with clinical features suggestive of RT. 18F-FDG PET/CT done in our case showed liver and lung involvement with no lymphadenopathy, which is an unusual presentation of RT.
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Affiliation(s)
- Apurva Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwin Singh Parihar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Department of Internal Medicine and Clinical Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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10
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Abstract
Richter's syndrome (RS) is a life-threatening complication of chronic lymphocytic leukemia (CLL). While previous research has increased our knowledge on the distinct evolutionary patterns of RS and provided a deeper understanding of the risk factors and molecular events predisposing to transformation, there remain few targetable aberrations and treatment is largely ineffective. The ability to obtain deeper remissions, without selecting for deletion 17p, by using novel B-cell receptor (BCR) antagonists and bcl2 inhibition might lead to a decrease in the incidence of RS, but these agents have done little to significantly change outcomes when incorporated into treatment regimens for RS. In this review we highlight the current landscape of molecular lesions specific to RS, review the data on historical treatment options, and look to the horizon for potential opportunities in the future.
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Affiliation(s)
- John N Allan
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Richard R Furman
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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11
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Puckrin R, Pop P, Ghorab Z, Keith J, Chodirker L, Lin Y, Callum J. Intravascular large B-cell lymphoma presenting as Richter's syndrome with cerebral involvement in a patient with chronic lymphocytic leukemia. Clin Case Rep 2017; 5:1444-1449. [PMID: 28878900 PMCID: PMC5582220 DOI: 10.1002/ccr3.1087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 06/17/2017] [Indexed: 11/08/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is an aggressive non-Hodgkin's lymphoma which can present with B symptoms, rash, and neurological deterioration. Up to 10% of cases of IVLBCL are associated with other hematological neoplasms, including this extremely rare presentation of IVLBCL as Richter's transformation in chronic lymphocytic leukemia.
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Affiliation(s)
- Robert Puckrin
- Postgraduate Medical Education University of Toronto Toronto Ontario Canada
| | - Paula Pop
- Postgraduate Medical Education University of Toronto Toronto Ontario Canada
| | - Zeina Ghorab
- Department of Anatomic Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Julia Keith
- Department of Anatomic Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Lisa Chodirker
- Department of Hematology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Yulia Lin
- Department of Clinical Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Jeannie Callum
- Department of Clinical Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
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