Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature

Beltrán, Brady E; Quiñones, Pilar; Morales, Domingo; Alva, José; Miranda, Roberto N.; Lu, Gary; Shah, Bijal; Sotomayor, Eduardo M.; Castillo, Jorge J.

doi:10.1016/j.leukres.2013.05.016

Cited by 21 publications

(18 citation statements)

References 28 publications

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“…Circulating cells of follicular lymphoma are seen in many cases, but leukemic involvement ranges from 4–23% 16. Four of our cases had a detectable leukemic phase at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 64%

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Sylvia

Dey

Basu

et al. 2016

Mediterr J Hematol Infect Dis

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IntroductionFollicular lymphoma (FL) is an indolent lymphoproliferative disorder of B-cells with variable clinical behavior. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia.Materials and methodsCases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details, and immunohistochemical markers CD20, CD10 and BCL-2 were recorded in all the cases.ResultsOf the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill were seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4.ConclusionThe incidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. The study highlights features of low grade with high proliferation index, granulomatous response, leukemic involvement, and transformation to high grade lymphoma.

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Section: Discussionmentioning

confidence: 64%

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Sylvia

Dey

Basu

et al. 2016

Mediterr J Hematol Infect Dis

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“…A leukaemic phase of follicular lymphoma at presentation is exceedingly uncommon; particularly, a leucocytosis of 1 327 000/μL is unheard of. At this time, rituximab-containing therapies are the most commonly used treatment modalities with variable outcomes 1 4. The seven cases from Beltran et al 4 were all treated with rituximab-containing therapies with two achieving remission with autologous stem cell transplant.…”

Section: Discussionmentioning

confidence: 99%

“…Beltran et al 4 describes seven cases of follicular lymphoma presenting with a leukaemic phase at diagnosis with the highest degree of leucocytosis, reported at 226 950/μL. Inaba et al 1 reported two cases with hyperleucocytosis greater than 500×10 9 /L.…”

Section: Introductionmentioning

confidence: 99%

Follicular lymphoma presenting as hyperleucocytosis

Cochrane

Aljadir

2020

BMJ Case Rep

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Follicular lymphoma is the second most common subtype of non-Hodgkin's lymphoma affecting adults. Clinically, follicular lymphoma is generally indolent, most often presenting as a painless peripheral lymphadenopathy; however, a leucocytosis at presentation is exceedingly rare. We present the case of a 63-year-old woman with follicular lymphoma with a presenting hyperleucocytosis at diagnosis of 1 327 000/μL demonstrated on laboratory analysis work while hospitalised for progressive weakness. fluorescence in situ hybridization (FISH) panel was consistent with follicular lymphoma, which was positive for B-cell leukaemia/lymphoma 2 and negative for MYC Proto-Oncogene. Cytoreduction with rituximab-containing therapy was initiated, with the patient ultimately expiring. A leukaemic phase at presentation appears to be associated with poor outcome. The findings from our case, in addition to others, have potential implications in regard to prognostic utility. The current prognostic tool used to estimate overall survival for follicular lymphoma, Follicular Lymphoma International Prognostic Index, does not take leucocytosis into account.

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“…In the absence of cytogenetic information, our second case would have been classified as follicular lymphoma in leukemic phase given the morphologic features, low Ki67 proliferation index, and low S-phase fraction. Beltran et al have described 7 patients with the pathologic diagnosis of follicular lymphoma who presented with leukemia [14]. These cases followed an aggressive clinical course.…”

Section: Discussionmentioning

confidence: 99%

Leukemic presentation of high-grade B cell lymphoma with MYC and BCL2 rearrangement—a series of two cases and review of literature

2019

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High-grade B cell lymphoma (HGBL) is a recently introduced category of aggressive mature B cell lymphoma which is clinically and biologically distinct from diffuse large B cell lymphoma (DLBCL), NOS, and Burkitt Lymphoma. HGBL consists of two categories; the first category includes HGBL with MYC and BCL2 and/or BCL6 rearrangement which is so-called double or triple hit lymphoma. The second category includes HGBL, NOS which lacks genetic double or triple hit; however, its morphology is intermediate between DLBCL and Burkitt lymphoma or appear blastoid. Clinically, patients present with advanced disease, bone marrow involvement, elevated lactate dehydrogenase (LDH), extranodal disease which includes CNS involvement and a high international prognostic index (IPI). Leukemic presentation has been described in various types of B and T cell non-Hodgkin lymphoma; however, peripheral blood involvement as an initial presentation is seldom described in the literature for HGBL with MYC and BCL2 rearrangement. Here, we report two cases of HGBL whose initial presentation was leukocytosis with peripheral blood involvement mimicking acute leukemia.

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Follicular lymphoma with leukemic phase at diagnosis: A series of seven cases and review of the literature

Cited by 21 publications

References 28 publications

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary care Institute in Southern India

Follicular lymphoma presenting as hyperleucocytosis

Leukemic presentation of high-grade B cell lymphoma with MYC and BCL2 rearrangement—a series of two cases and review of literature

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