Classic Hodgkin Lymphoproliferative Diseases Clonally Unrelated to B-Chronic Lymphocytic Leukemia Successfully Treated with Bendamustine Plus Rituximab

Abstract

A 62-year-old male was diagnosed with B-CLL and treated with Fludarabine-containing regimen which maintained the disease in partial response. Nine years after diagnosis, a rapidly growing systemic lymphadenopathy was observed, and a biopsy specimen revealed the presence of typical Hodgkin/Reed–Sternberg (HRS) cells, surrounded by T-lymphocytes and CLL cells. Sequencing analysis of the germline CDR3 region of the IGH gene showed that the HRS cells were clonally unrelated to the preexisting CLL cells and the HRS cells were composed of five different clones, leading to the molecular diagnosis of de novo lymphocyte-rich classic Hodgkin LPDs with SLL. Because the initial treatment was neither effective for classic Hodgkin LPDs nor for SLL, Bendamustine, Rituximab (BR) was started and complete remission was achieved, which has continued for more than one year so far. BR may be a good therapeutic option for both entities without causing hematological toxicity.

Co‐occurrence of EBV‐positive classic Hodgkin lymphoma and B‐cell lymphomas of different clonal origins: A case report and literature review

“…Seven cases with co‐occurrent tumors of B‐NHL and CHL, in which only HRS cells in the CHL component were associated with EBV, were also reported, and the clonal relationship was analyzed for these cases. Six of them showed a clonal relationship between B‐NHL and CHL 1,3,4 . In one of these cases, EBV‐positive HRS cells displayed subclonal heterogeneity, suggesting that EBV infection was a late event 1 .…”