Acute Lymphoblastic Crisis in a Patient with Chronic Lymphatic Leukemia

Abstract

A case of chronic lymphatic leukemia terminating in a lymphoblastic crisis is described. The small lymphocytes were demonstrated to be B cells, they carried immunoglobulins on their surface and formed EAC rosettes. The lymphoblasts had no immunoglobulins on their surface and only 18% of them formed EAC rosettes, none formed E rosettes. The lymphoblasts could be either immature B cells or Null cells.

Acute Blast Crisis in a Patient with Chronic Lymphocytic Leukemia

“…More over, in 1 patient these authors showed that membrane-bound Ig of the small lympho cytes and of the lymphoblastic cells showed the same antibody activity, providing defini tive evidence that both types of proliferating cells originated from the same clone. The results are different from those obtained by Klajman et al [8] …”

“…To our knowledge, surface marker stud ies supervening on CCL in acute blast crisis were performed in only 3 cases [2,8], In such cases a direct immunofluorescence procedure was used to detect membranebound immunoglobulins. In routine practice the immunofluorescence procedure allowed a good evaluation of cell size but was un able to give more cytological details, still es sential to realize a good discrimination be tween the two cell populations.…”

“…In routine practice the immunofluorescence procedure allowed a good evaluation of cell size but was un able to give more cytological details, still es sential to realize a good discrimination be tween the two cell populations. Thus, in some of these cases, morphological identifi cation of cells required some special proce dures such as an alternative examination in phase-contrast and in ultraviolet light [2] or separation by a density gradient [8]. The immunoperoxidase procedure has been shown to be a good alternative to detect cel lular Ig in human neoplastic lymphoid cells because of a good morphological identifica tion based on routine counterstaining re agents.…”

“…The occurrence of an acute blast crisis in patients with chronic lymphocytic leukemia (CLL) has been infrequently reported [1-3, 8,11]. Furthermore, surface markers have been studied in only 3 cases.…”

Initial Clonal Acute Lymphoblastic Transformation of Chronic Lymphocytic Leukemia with (11;14) and (8;12) Chromosome Translocations and Acquired Homozygosity

“…Prolymphocytic transformation is more frequently observed [1], followed by transfor mation into a diffuse large cell lymphoma, known as Richter's syndrome [2]. Acute lymphoblastic transfor mation of CLL is rare, although it has been reported in several instances [3][4][5][6][7][8][9][10], and only in 2 reports was blast crisis the initial manifestation of CLL [9,10], raising the question of whether transformation of CLL corresponded to a clonal evolution of the initial population of malignant lymphocytes or to a second malignancy with the emergence of a second unrelated clone of less differentiated lymphoid cells arising in a susceptible host, as already described in Richter's 1 We thank Dr. G.M. Lenoir (IARC, Lyon) for kindly revising the manuscript.…”