Richter’s syndrome (RS) is the next step in the progression of chronic lymphocytic leukemia (CLL) progression. It leads to reduced overall patient survival, the necessity of aggressive chemotherapy and a decline in the quality of life. The first line of RS treatment includes traditional chemotherapy such as rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. However, during the past decade, novel targeted agents added to the therapy dramatically changed the treatment outcome for patients with RS. In our case, we describe a patient with CLL that had progressed to RS and achieved complete remission that lasted > 15 months with venetoclax monotherapy.

Extramedullary and paraskeletal plasmacytomas are not common and are usually one of the possible complications of multiple myeloma. This variant of the disease is more aggressive, less responsive to therapy, and recurs more often than conventional multiple myeloma. In our work, we described two cases of aggressively ongoing multiple myeloma with a mixed plasmacytic variant diagnosed at the time of setting the diagnosis. In both cases, a rapid progressive course was observed despite the wide range of both the newest drugs and the classical chemotherapy drugs used during treatment. Thus, this variant of the disease remains most often resistant to the therapy, with an unfavorable prognosis, and requires further study and improvement of the treatment approach to improve outcomes.

Two clinical cases are described. The information about long-term febrile patients who had lymphadenopathy and splenomegaly is given. A large-scale and lengthy diagnostic search was carried out. During examination, hematological and rheumatological diseases were excluded. Diagnosis by exclusion showed that the clinical picture was associated with previous multiple vaccinations. In both cases, a post-vaccination reaction with systemic inflammatory response syndrome was diagnosed.