氟达拉滨
浆母细胞性淋巴瘤
慢性淋巴细胞白血病
淋巴瘤
医学
免疫缺陷
侵袭性淋巴瘤
淋巴增殖性病變
病理
霍奇金淋巴瘤
白血病
免疫学
肿瘤科
化疗
美罗华
内科学
环磷酰胺
免疫系统
作者
Wen‐Chi Foo,Qin Huang,Siby Sebastian,Charles Blake Hutchinson,Jim Burchette,Endi Wang
出处
期刊:Human Pathology
[Elsevier]
日期:2010-12-01
卷期号:41 (12): 1802-1808
被引量:25
标识
DOI:10.1016/j.humpath.2010.04.019
摘要
A small fraction of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma develop Epstein-Barr virus–positive B-cell lymphoproliferative disorders. These Epstein-Barr virus–B-cell lymphoproliferative disorders are thought to be related to immune suppression induced by fludarabine/other chemotherapeutic regimens. As in other immunodeficiency-associated lymphoproliferative disorders, these disorders demonstrate a heterogeneous histological spectrum that ranges from polymorphic to monomorphic to classical Hodgkin lymphoma–like lesions. We report a case of concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine. Both classical Hodgkin lymphoma and plasmablastic lymphoma were positive for Epstein-Barr virus-encoded RNA, whereas classical Hodgkin lymphoma was also positive for Epstein-Barr virus- latent membrane protein 1, suggesting a different viral latency. Immunoglobulin gene rearrangement studies demonstrated distinct clones in the plasmablastic lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma. These findings suggest biclonal secondary lymphomas associated with iatrogenic immunodeficiency. Epstein-Barr virus–B-cell lymphoproliferative disorders in the setting of chronic lymphocytic leukemia/small lymphocytic lymphoma, in particular those arising after chemotherapy, should be separated from true Richter's transformation, and be categorized as (iatrogenic) immunodeficiency-associated lymphoproliferative disorder.
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