DOCSLIB.ORG

Leukemic Phase of B-Cell Lymphomas Mimicking Chronic Lymphocytic Leukemia and Variants at Presentation Beverly P

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Leukemic Phase of B-Cell Lymphomas Mimicking Chronic Lymphocytic Leukemia and Variants at Presentation Beverly P Leukemic Phase of B-Cell Lymphomas Mimicking Chronic Lymphocytic Leukemia and Variants at Presentation Beverly P. Nelson, M.D., Daina Variakojis, M.D., LoAnn C. Peterson, M.D. Section of Hematopathology, Northwestern University Medical School, Chicago, Illinois KEY WORDS: Chronic lymphocytic leukemia, FISH, Six cases of non-Hodgkin B-cell lymphoma that Follicle center lymphoma, Mantle cell lymphoma, mimicked either chronic lymphocytic leukemia Prolymphocytic leukemia. (CLL) or a CLL variant at presentation are reported. Mod Pathol 2002;15(11):1111–1120 The patients ranged from 54 to 89 years and in- cluded three females and three males. All six pa- Chronic lymphocytic leukemia is a disease of older tients had prominent peripheral blood lymphocyto- adults. The clinical course is variable; many pa- sis at presentation; the initial morphologic tients have an indolent, slowly progressive disease impression was CLL in three cases, CLL/prolympho- lasting several years, whereas others have a more cytic leukemia (PLL) in two cases, and PLL in one. rapid downhill course with survival of less than 1–2 Five patients had bone marrow biopsies; each years (1, 2). CLL is characterized by absolute lym- showed a lymphoid infiltrate in a focally random, phocytosis in the peripheral blood and bone mar- interstitial, and/or diffuse pattern. Flow cytometric row at the time of diagnosis. The lymphocytes are immunophenotyping showed CD20-positive B cells typically small and mature appearing, but Յ10% with surface immunoglobulin (Ig) light chain re- circulating prolymphocytes may be present. CLL/ striction in all six patients. The five cases resembling prolymphocytic leukemia (PLL) is the designation CLL or CLL/PLL had at least a subset of CD5- used when between 10 and 55% prolymphocytes positive B cells, whereas CD5 was absent in the one are present at diagnosis. Cases with Ͼ55% prolym- case that resembled PLL. CD23 was positive in three phocytes are regarded as PLL (3). Patients with de of the four cases studied that resembled CLL or novo PLL typically present with high white blood CLL/PLL; CD79b was positive in three, FMC7 was cell counts, splenomegaly, and clinically aggressive positive in two, and surface Ig and CD20 were disease (3). brightly positive in three. A t(11;14) (q13;q32) was Non-Hodgkin lymphomas also may have exten- found in four cases that resembled CLL or CLL/PLL; sive bone marrow and peripheral blood involve- they were subsequently diagnosed as mantle cell ment at initial presentation. Lymphomas that fre- lymphoma. The remaining two cases mimicking quently exhibit circulating lymphoma cells include CLL or PLL were diagnosed as lymphomas of follicle mantle cell lymphoma (MCL) and follicle center center origin with leukemic phase based on the lymphoma (FCL; 4–6); however, a prominent pe- presence of t(14;18) (q32;q21). Thus although the ripheral blood lymphocytosis at diagnosis is un- morphology of these six cases resembled CLL or common. Circulating FCL cells are typically small variants, and immunophenotyping by flow cytom- with scant cytoplasm and cleaved or irregular nu- etry showed overlapping features, genetic studies clei. Cells from MCL are usually intermediate in size enabled distinction of these leukemic non-Hodgkin with variable morphology, including round or irreg- lymphoma from chronic lymphocytic leukemia or ular nuclei, frequent visible nucleoli, and variable variants. amounts of cytoplasm (7–9). Recognition of the leukemic counterpart of non- Hodgkin lymphoma is facilitated when the leuke- Copyright © 2002 by The United States and Canadian Academy of mia occurs as a late complication of preexisting Pathology, Inc. disease. Non-Hodgkin lymphoma is less obvious if VOL. 15, NO. 11, P. 1111, 2002 Printed in the U.S.A. Date of acceptance: July 3, 2002. a leukemic phase occurs at presentation. We de- Address reprint requests to: Beverly P. Nelson, M.D., Northwestern Me- scribe the clinical, morphologic, immunopheno- morial Hospital, Galter 7-239, 251 E. Huron, Chicago, IL 60611; e-mail: [email protected]; fax: 312-926-0560. typic, and cytogenetic findings of 6 cases of non- DOI: 10.1097/01.MP.0000031710.32235.24 Hodgkin, B-cell lymphomas that presented with 1111 extensive peripheral blood involvement and that were morphologically indistinguishable from CLL, CLL/PLL, or PLL. METHODS/CASE REPORTS Four cases of B-cell lymphoma that manifested with leukocytosis and absolute lymphocytosis and morphology resembling CLL or variants were en- countered between December 1998 and September 2001. Two additional cases, one from 1989 and the other from 1993, were identified retrospectively from the files of one author (LP). Each patient had a complete blood cell count with differential. Bone marrow aspirates and biopsies were obtained from all but one patient (Case 3), and a lymph node biopsy was obtained from one patient (Case 2). Sections of bone marrow and lymph node were fixed in formalin or B5, routinely processed, and stained with hematoxylin and eosin (H&E). Wright- Giemsa–stained peripheral blood smears and Wright-Giemsa–stained bone marrow aspirate smears were reviewed. Immunophenotyping by flow cytometry of bone marrow aspirate and/or peripheral blood was performed as previously de- scribed (10). Samples were stained and analyzed within 24 hours of collection. Immunohistochem- FIGURE 1. Patient 1. A, Peripheral blood smear from a patient with istry for cyclin D1 (clone DCS-6, DAKO Corpora- mantle cell lymphoma resembling CLL/PLL. The majority of the tion, Carpenteria, CA) was performed on formalin- lymphocytes are small, mature appearing; a few show looser chromatin fixed, paraffin-embedded lymph node sections. and large nucleoli. B, Bone marrow core biopsy involved by mantle cell lymphoma showing one of multiple intertrabecular lymphoid Conventional cytogenetic studies were performed aggregates. as previously published (11). Fluorescence in situ hybridization (FISH) was performed according to the manufacturer’s directions using commercially ther studies were recommended. A bone marrow available t(11;14) and t(14;18) dual-fusion probes biopsy showed random focal nodular and an inter- (Vysis, Downers Grove, IL). stitial lymphoid infiltrate composed of small lym- phocytes with condensed chromatin and about 20% large lymphoid cells with distinct nucleoli (Fig. Case 1 1B) A 71-year-old female was diagnosed with CLL in Immunophenotyping by flow cytometry of the September 1997 based on an absolute lymphocyto- peripheral blood showed bright kappa surface im- sis in the peripheral blood with mature-appearing munoglobulin (Ig) light chain restricted B cells that lymphocytes. She was monitored for disease pro- were dim CD20 positive, partially CD5 positive, gression but not treated. Three years after the initial CD23 positive, bright CD79b positive, FMC7 nega- diagnosis (August 2000), she was referred to North- tive, and CD10 negative (Table 2). The bone mar- western Memorial Hospital for further evaluation row showed similar immunophenotypic findings as because of increased fatigue as well as new onset of the peripheral blood although all the monoclonal splenomegaly and cervical lymphadenopathy. B-cells were CD5 negative, and both CD20 and the At the time of referral, the white blood cell count surface immunoglobulin staining intensity were (white blood cell count) was 143.4 ϫ 109/L; hemo- bright. Conventional cytogenetic studies showed a globin (Hgb), 10.8 g/dL; and platelets (PLT), 146 ϫ complex karyotype with both numerical and struc- 109/L. The differential showed 94% lymphocytes, tural anomalies detailed in Table 3. Fluorescence in 4% neutrophils, and 2% monocytes. The lympho- situ hybridization (FISH) studies demonstrated cy- cytes were mostly small and mature appearing but clin D1 (CCND1) and Ig heavy chain fusion in 93.8% included 15% larger cells with ample cytoplasm and of the 500 nuclei examined compatible with t(11;14) central nucleoli consistent with prolymphocytes (q13;q32); this abnormality was not identified by (Fig. 1A). A presumptive diagnosis of CLL/PLL was the conventional cytogenetics. Based on the results made based on the morphologic findings, and fur- of all of the above studies, MCL was diagnosed. 1112 Modern Pathology TABLE 1. Clinical Findings at Presentation Absolute Case Follow-up Age (y)/sex Lymphocyte Adenopathy Splenomegaly Initial Dx Final Dx No. (mo) Count (per ␮L) 1 71/F 134,796 Present Present D (49) CLL/PL MCL 2 54/F 66,309 Present Present D (19) CLL MCL 3 78/F 22,670 Absent Present A (3) CLL/PL MCL 4 71/M 11,765 Present Unknown A (60) CLL MCL 5 89/M 56,588 Absent Absent D (50) CLL FL 6 57/M 24,624 Present Present A (6) PLL FL A, alive; D, dead. TABLE 2. Flow Cytometric Immunophenotypic Findings Case CD20 Light Chain Specimen CD5 CD10 CD23 FMC7 CD79b No. Intensity (Intensity) 1PBϩϪ ϩ Ϫ ϩDim Kappa (bright) BM ϪϪ ϩ Ϫ ϩBright Kappa (bright) 2PBϩϪ Ϫ ϩ ϩBright Kappa (bright) 3BMϩϪ ϩ ϩ ϩBright Kappa (bright) 4PBϩ ND ϩ/dim ND ND Dim Lambda (bright) 5PBϩ ND ND ND ND NA Lambda (NA) 6PBϪϩ/dim Ϫ ND ND Bright Lambda (bright) PB, peripheral blood; BM, bone marrow; ND, not done; NA, not available; ϩ, positive; Ϫ, negative. TABLE 3. Cytogenetic Findings showed white blood cell count of 180 ϫ 109/L; Hgb, Case ϫ 9 Cytogenetic Results 9.8 g/dL; Hct, 30.5%; and PLT, 42 10 /L. The No. differential showed 91% lymphocytes and 9% neu- 1 45, XX, add(2)(q27), add(3)(p11), add(6)(p11.2), add(9)(q34), trophils. Most lymphocytes (Fig. 2A) were small add(10)(p11.2), add(18)(q21), Ϫ22[12]. FISH: CCND1/IgH fusion in 93.8% of 500 nuclei. with condensed chromatin and scant cytoplasm; 2 46, XX, add(5)(p15.1), del(8)(p11.2), t(11;14)(q13;qq32), [19]/46, there were also rare cells compatible with prolym- idem, add(12)(p13) [1]/47, X, add(X), (p22.1), add (5) (p15.1), Ϫ8, phocytes.
Load more

Recommended publications
  • Follicular Lymphoma
    Follicular Lymphoma What is follicular lymphoma? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines FOLLICULAR LYMPHOMA: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by the Anticancer Fund as a service to patients, to help patients and their relatives better understand the nature of follicular lymphoma and appreciate the best treatment choices available according to the subtype of follicular lymphoma. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. The medical information described in this document is based on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the management of newly diagnosed and relapsed follicular lymphoma. This guide for patients has been produced in collaboration with ESMO and is disseminated with the permission of ESMO. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the lead author of the clinical practice guidelines for professionals, as well as two oncology nurses from the European Oncology Nursing Society (EONS). It has also been reviewed by patient representatives from ESMO’s Cancer Patient Working Group. More information about the Anticancer Fund: www.anticancerfund.org More information about the European Society for Medical Oncology: www.esmo.org For words marked with an asterisk, a definition is provided at the end of the document. Follicular Lymphoma: a guide for patients - Information based on ESMO Clinical Practice Guidelines – v.2014.1 Page 1 This document is provided by the Anticancer Fund with the permission of ESMO.
    [Show full text]
  • Follicular Lymphoma with Leukemic Phase at Diagnosis: a Series Of
    Leukemia Research 37 (2013) 1116–1119 Contents lists available at SciVerse ScienceDirect Leukemia Research journa l homepage: www.elsevier.com/locate/leukres Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature a c c c c Brady E. Beltran , Pilar Quinones˜ , Domingo Morales , Jose C. Alva , Roberto N. Miranda , d e e b,∗ Gary Lu , Bijal D. Shah , Eduardo M. Sotomayor , Jorge J. Castillo a Department of Oncology and Radiotherapy, Edgardo Rebagliati Martins Hospital, Lima, Peru b Division of Hematology and Oncology, Rhode Island Hospital, Brown University Alpert Medical School, Providence, RI, USA c Department of Pathology, Edgardo Rebaglati Martins Hospital, Lima, Peru d Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, USA e Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA a r t i c l e i n f o a b s t r a c t Article history: Follicular lymphoma (FL) is a prevalent type of non-Hodgkin lymphoma in the United States and Europe. Received 23 April 2013 Although, FL typically presents with nodal involvement, extranodal sites are less common, and leukemic Received in revised form 25 May 2013 phase at diagnosis is rare. There is mounting evidence that leukemic presentation portends a worse Accepted 26 May 2013 prognosis in patients with FL. We describe 7 patients with a pathological diagnosis of FL who presented Available online 20 June 2013 with a leukemic phase. We compared our cases with 24 additional cases reported in the literature. Based on our results, patients who present with leukemic FL tend to have higher risk disease.
    [Show full text]
  • Non-Hodgkin's Lymphoma Questions and Answers
    Non-Hodgkin's Lymphoma Questions and Answers What is Non-Hodgkin's Lymphoma? Non-Hodgkin’s lymphoma (NHL) is a cancer of the lymphocytes, a type of white blood cell. When lymphocytes become cancerous (malignant), they multiply and become tumors. Lymphocytes are normally found in the blood stream and lymph nodes. Lymph nodes are found throughout the body and are identified by their location. They are a part of the body’s immune system, which includes the lymphatic system, spleen and lymphocytes. Some lymph nodes can be found just by feeling them in the neck, groin or under the arms. Some cannot be felt, but they can be seen on X-rays. NHL is the fifth most common cancer in the United States. Men are at slightly higher risk than women. It is more common in adults than children. The average age at diagnosis is 45 to 55 years. The cause of NHL remains unknown. What Are the Types and Symptoms of Non-Hodgkin’s Lymphoma? There are more than 30 different types of NHL. The specific types of NHL are associated with different symptoms. Low-grade or indolent NHL is usually associated with painless swelling of lymph nodes (usually in the neck or over the collarbone), but patients are otherwise healthy. The swelling may go away for a while, but then return. If the low-grade NHL has spread outside of the lymph nodes, such as to the stomach, there may be discomfort in the affected area. Low-grade lymphomas grow slowly. Examples of low-grade NHLs include: Marginal zone lymphomas.
    [Show full text]
  • Non-Hodgkin Lymphoma Booklet
    Understanding Non-Hodgkin Lymphoma A Guide for Patients, Survivors, and Loved Ones October 2017 Lymphoma Research Foundation (LRF) Helpline and Clinical Trials Information Service CONTACT THE LRF HELPLINE Trained staff are available to answer questions and provide support to patients, caregivers and healthcare professionals in any language. Our support services include: • Information on lymphoma, treatment options, side effect management and current research fi ndings • Financial assistance for eligible patients and referrals for additional fi nancial, legal and insurance help • Clinical trial searches based on patient’s diagnosis and treatment history • Support through LRF’s Lymphoma Support Network, a national one-to one volunteer patient peer program Monday through Friday, Toll-Free (800) 500-9976 or email [email protected] Understanding Non-Hodgkin Lymphoma A Guide For Patients, Survivors, and Loved Ones October 2017 This guide is an educational resource compiled by the Lymphoma Research Foundation to provide general information on adult non- Hodgkin lymphoma. Publication of this information is not intended to replace individualized medical care or the advice of a patient’s doctor. Patients are strongly encouraged to talk to their doctors for complete information on how their disease should be diagnosed, treated, and followed. Before starting treatment, patients should discuss the potential benefits and side effects of cancer therapies with their physician. Contact the Lymphoma Research Foundation Helpline: (800) 500-9976 [email protected] Website: www.lymphoma.org Email: [email protected] This patient guide is supported through unrestricted educational grants from: © 2017 Lymphoma Research Foundation. Information contained herein is the property of the Lymphoma Research Foundation (LRF).
    [Show full text]
  • MINI-REVIEW Large Cell Lymphoma Complicating Persistent Polyclonal B
    Leukemia (1998) 12, 1026–1030 1998 Stockton Press All rights reserved 0887-6924/98 $12.00 http://www.stockton-press.co.uk/leu MINI-REVIEW Large cell lymphoma complicating persistent polyclonal B cell lymphocytosis J Roy1, C Ryckman1, V Bernier2, R Whittom3 and R Delage1 1Division of Hematology, 2Department of Pathology, Saint Sacrement Hospital, 3Division of Hematology, CHUQ, Saint Franc¸ois d’Assise Hospital, Laval University, Quebec City, Canada Persistent polyclonal B cell lymphocytosis (PPBL) is a rare immunoglobulin (Ig) M with a polyclonal pattern on protein lymphoproliferative disorder of unclear natural history and its electropheresis. Flow cytometry cell analysis displays the pres- potential for B cell malignancy remains unknown. We describe the case of a 39-year-old female who presented with stage IV- ence of the CD19 antigen and surface IgM with a normal B large cell lymphoma 19 years after an initial diagnosis of kappa/lambda ratio. In contrast to CLL, CD5 is absent. There PPBL; her disease was rapidly fatal despite intensive chemo- is an association between HLA-DR 7 and PPBL in more than therapy and blood stem cell transplantation. Because we had two-thirds of the patients but the reason for such an associ- recently identified multiple bcl-2/lg gene rearrangements in ation remains unclear.3,6 There has been one report of PPBL blood mononuclear cells of patients with PPBL, we sought evi- occurring in identical female twins.7 No other obvious genetic dence of this oncogene in this particular patient: bcl-2/lg gene rearrangements were found in blood mononuclear cells but not predisposition or familial inheritance has yet been described in lymphoma cells.
    [Show full text]
  • Hodgkin Lymphoma
    Hodgkin Lymphoma Erica, Hodgkin lymphoma survivor Revised 2016 Publication Update Hodgkin Lymphoma The Leukemia & Lymphoma Society wants you to have the most up-to-date information about blood cancer treatment. See below for important new information that was not available at the time this publication was printed. In May 2017, the Food and Drug Administration (FDA) approved nivolumab (Opdivo®) for the treatment of adult patients with classical Hodgkin lymphoma (HL) that has relapsed or progressed after 3 or more lines of systemic therapy that includes autologous hematopoietic stem cell transplantation (HSCT). It is also approved for the treatment of adult patients with classical HL that has relapsed or progressed after autologous HSCT and brentuximab vedotin. These indications are approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. In March 2017, the Food and Drug Administration (FDA) approved pembrolizumab (Keytruda®) for the treatment of adult and pediatric patients with refractory classical Hodgkin lymphoma (cHL), or who have relapsed after 3 or more prior lines of therapy. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. For more information, contact an Information Specialist at (800) 955-4572 or [email protected]. Information Specialists: 800.955.4572 I www.LLS.org PS57 A Message from Louis J. DeGennaro, PhD President and CEO of The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society (LLS) is the world’s largest voluntary health organization dedicated to finding cures for blood cancer patients.
    [Show full text]
  • B- and T-Cell Neoplasm Features and Fine Points
    B- and T-cell neoplasm features and fine points Karen Lusky June 2021—A case of monoclonal B-cell lymphocytosis and a tour of B- and T-cell morphologies were at the heart of a CAP20 virtual presentation on neoplastic lymphocytosis. Kyle Bradley, MD, associate professor of hematopathology and director of surgical pathology at Emory University, spoke last fall on reactive (CAP TODAY, May 2021) and neoplastic lymphocytosis, with Olga Pozdnyakova, MD, PhD, who addressed neutrophilia and monocytosis (CAP TODAY, February and March 2021). Together they took attendees through a morphology-based approach to hematopoietic neoplasms presenting with an abnormal WBC differential. “Some malignant lymphocytes can closely resemble normal cells,” Dr. Bradley said in a recent interview. “The classic example would be chronic lymphocytic leukemia because individual lymphocytes in that neoplasm can look very similar to normal lymphocytes.” Dr. Bradley shared the case of a 59-year-old man with a clonal B-cell population identified by flow cytometry. It was positive for CD19, CD20, CD5, CD23, CD200, and Kappa, and negative for CD10, FMC7, and Lambda. “This is a typical phenotype for chronic lymphocytic leukemia/small lymphocytic lymphoma,” he said. However, “the blood smear is not what you typically think of for CLL.” (Fig. 1). The differential diagnosis is CLL versus monoclonal B-cell lymphocytosis, he said. In the current and previous WHO classification, CLL requires greater than 5.0 × 109/L clonal B cells. Lower counts are acceptable if there are signs or symptoms of lymphoma. Monoclonal B-cell lymphocytosis is defined as ≤ 5.0 × 109/L clonal B cells in otherwise healthy subjects.
    [Show full text]
  • Lymphoproliferative Disorders
    Lymphoproliferative disorders Dr. Mansour Aljabry Definition Lymphoproliferative disorders Several clinical conditions in which lymphocytes are produced in excessive quantities ( Lymphocytosis) Lymphoma Malignant lymphoid mass involving the lymphoid tissues (± other tissues e.g : skin ,GIT ,CNS …) Lymphoid leukemia Malignant proliferation of lymphoid cells in Bone marrow and peripheral blood (± other tissues e.g : lymph nods ,spleen , skin ,GIT ,CNS …) Lymphoproliferative disorders Autoimmune Infection Malignant Lymphocytosis 1- Viral infection : •Infectious mononucleosis ,cytomegalovirus ,rubella, hepatitis, adenoviruses, varicella…. 2- Some bacterial infection: (Pertussis ,brucellosis …) 3-Immune : SLE , Allergic drug reactions 4- Other conditions:, splenectomy, dermatitis ,hyperthyroidism metastatic carcinoma….) 5- Chronic lymphocytic leukemia (CLL) 6-Other lymphomas: Mantle cell lymphoma ,Hodgkin lymphoma… Infectious mononucleosis An acute, infectious disease, caused by Epstein-Barr virus and characterized by • fever • swollen lymph nodes (painful) • Sore throat, • atypical lymphocyte • Affect young people ( usually) Malignant Lymphoproliferative Disorders ALL CLL Lymphomas MM naïve B-lymphocytes Plasma Lymphoid cells progenitor T-lymphocytes AML Myeloproliferative disorders Hematopoietic Myeloid Neutrophils stem cell progenitor Eosinophils Basophils Monocytes Platelets Red cells Malignant Lymphoproliferative disorders Immature Mature ALL Lymphoma Lymphoid leukemia CLL Hairy cell leukemia Non Hodgkin lymphoma Hodgkin lymphoma T- prolymphocytic
    [Show full text]
  • Understanding Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma
    Understanding Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are forms of non-Hodgkin lymphoma (NHL) that arise from B lymphocytes. CLL and SLL are essentially the same disease, with the only difference being the location where the cancer primarily occurs. When most of the cancer cells are located in the bloodstream and the bone marrow, the disease is referred to as CLL, although the lymph nodes and spleen are often involved. When the cancer cells are located mostly in the lymph nodes and are less frequent in the blood, the disease is called SLL. Many patients with CLL/SLL do not have any obvious symptoms of the disease. Their doctors might detect the disease during routine blood tests and/or a physical examination. For others, the disease is detected when symptoms occur and the patient goes to the doctor because he or she is worried, uncomfortable, or does not feel well. CLL/SLL may cause different symptoms depending on the location of the tumor in the body, including fatigue (extreme tiredness), shortness of breath, anemia (low red blood cell count), bruising easily, night sweats, weight loss, frequent infections. Other symptoms can include a swollen abdomen and feeling full even after eating only a small amount. However, many patients with CLL/SLL will live for years without symptoms. TREATMENT OPTIONS • Chlorambucil (Leukeran) and obinutuzumab (Gazyva) • Venetoclax (Venclexta) and obinutuzumab (Gazyva) Treatment is based on the severity of associated symptoms Occasionally patients might also be treated with chemotherapy, as well as the rate of cancer growth.
    [Show full text]
  • NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines® ) Non-Hodgkin’S Lymphomas Version 2.2015
    NCCN Guidelines Index NHL Table of Contents Discussion NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines® ) Non-Hodgkin’s Lymphomas Version 2.2015 NCCN.org Continue Version 2.2015, 03/03/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® . Peripheral T-Cell Lymphomas NCCN Guidelines Version 2.2015 NCCN Guidelines Index NHL Table of Contents Peripheral T-Cell Lymphomas Discussion DIAGNOSIS SUBTYPES ESSENTIAL: · Review of all slides with at least one paraffin block representative of the tumor should be done by a hematopathologist with expertise in the diagnosis of PTCL. Rebiopsy if consult material is nondiagnostic. · An FNA alone is not sufficient for the initial diagnosis of peripheral T-cell lymphoma. Subtypes included: · Adequate immunophenotyping to establish diagnosisa,b · Peripheral T-cell lymphoma (PTCL), NOS > IHC panel: CD20, CD3, CD10, BCL6, Ki-67, CD5, CD30, CD2, · Angioimmunoblastic T-cell lymphoma (AITL)d See Workup CD4, CD8, CD7, CD56, CD57 CD21, CD23, EBER-ISH, ALK · Anaplastic large cell lymphoma (ALCL), ALK positive (TCEL-2) or · ALCL, ALK negative > Cell surface marker analysis by flow cytometry: · Enteropathy-associated T-cell lymphoma (EATL) kappa/lambda, CD45, CD3, CD5, CD19, CD10, CD20, CD30, CD4, CD8, CD7, CD2; TCRαβ; TCRγ Subtypesnot included: · Primary cutaneous ALCL USEFUL UNDER CERTAIN CIRCUMSTANCES: · All other T-cell lymphomas · Molecular analysis to detect: antigen receptor gene rearrangements; t(2;5) and variants · Additional immunohistochemical studies to establish Extranodal NK/T-cell lymphoma, nasal type (See NKTL-1) lymphoma subtype:βγ F1, TCR-C M1, CD279/PD1, CXCL-13 · Cytogenetics to establish clonality · Assessment of HTLV-1c serology in at-risk populations.
    [Show full text]
  • Hodgkin's Disease Variant of Richter's Syndrome in Chronic Lymphocytic Leukaemia Patients Previously Treated with Fludarabin
    research paper Hodgkin’s disease variant of Richter’s syndrome in chronic lymphocytic leukaemia patients previously treated with fludarabine Dominic Fong,1 Alexandra Kaiser,2 Summary Gilbert Spizzo,1 Guenther Gastl,1 Alexandar Tzankov2 The transformation of chronic lymphocytic leukaemia (CLL) into large-cell 1Division of Haematology and Oncology and lymphoma (Richter’s syndrome, RS) is a well-documented phenomenon. 2Department of Pathology, Innsbruck Medical Only rarely does CLL transform into Hodgkin’s lymphoma (HL). To further University, Innsbruck, Austria analyse the clinico-pathological and genetic findings in the HL variant of RS, we performed a single-institution study in four patients, who developed HL within a mean of 107 months after diagnosis of CLL. All were treated with fludarabine. Three cases were Epstein–Barr virus (EBV)-associated mixed cellularity (MC) HL, the fourth was nodular sclerosis (NS) HL without EBV association. The sites involved by HL included supra- and infradiaphragmal lymph nodes and the tonsils; stage IV disease was also documented. All patients presented with CLL treatment-resistant lymphadenopathies and B- symptoms. In two of the MC cases, molecular analysis performed on CLL samples and microdissected Hodgkin and Reed–Sternberg cells (HRSC) suggested a clonal relationship, while in NS no indication of a clonal relationship was detected. In summary, HL can occur in CLL patients at any Received 15 December 2004; accepted for site, up to 17 years after initial diagnosis, especially after treatment with publication 1 February 2005 fludarabine. The majority present with B-symptoms and CLL treatment- Correspondence: A. Tzankov MD, Department resistant lymphadenopathy, are of the MC type, clonally related to CLL and of Pathology, Innsbruck Medical University, might be triggered by an EBV infection.
    [Show full text]
  • Chronic Lymphocytic Leukaemia (CLL) and Small Lymphocytic Lymphoma (SLL)
    Helpline (freephone) 0808 808 5555 [email protected] www.lymphoma-action.org.uk Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) This information is about chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL). CLL and SLL are different forms of the same illness. They are often grouped together as a type of slow-growing (low-grade or indolent) non-Hodgkin lymphoma. On this page What is CLL/SLL? Who gets CLL? Symptoms of CLL Diagnosis and staging Outlook Treatment Follow-up Relapsed or refractory CLL Research and targeted treatments We have separate information about the topics in bold font. Please get in touch if you’d like to request copies or if you would like further information about any aspect of lymphoma. Phone 0808 808 5555 or email [email protected]. Page 1 of 13 © Lymphoma Action What is CLL/SLL? Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) are slow-growing types of blood cancer. They develop when white blood cells called lymphocytes grow out of control. Lymphocytes are part of your immune system. They travel around your body in your lymphatic system, helping you fight infections. There are two types of lymphocyte: T lymphocytes (T cells) and B lymphocytes (B cells). CLL and SLL are different forms of the same illness. They develop when B cells that don’t work properly build up in your body. • In CLL, the abnormal B cells build up in your blood and bone marrow. This is why it’s called ‘leukaemia’ – after ‘leucocytes’: the medical name for white blood cells.
    [Show full text]