Hodgkin lymphoma transformation of chronic lymphocytic leukemia: cases report and discussion

Abstract

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is the most common form of leukemia affecting adults in Europe and North America. Large B-cell lymphoma known as Richter’s syndrome (RS) may develop approximately in 3–15 % patients. Furthermore, other hematological malignancies may also occur as RS variants, among them—Hodgkin lymphoma (HL). CLL/SLL transformation into HL is observed in about 0.5 % of patients, and till now, fewer than 100 cases have been reported in the medical literature. We present two cases of HL transformation of CLL/SLL and review the previously published literature.

Hodgkin lymphoma transformation of chronic lymphocytic leukemia—A real life data from the Polish Lymphoma Research Group

“…Our analysis confirms that HvRS can develop anytime since CLL/SLL diagnosis, being however a late event in the majority of patients. In our study, the median time of 3.2 years to HvRS from CLL/SLL diagnosis was shorter than the time reported by others (4.6‐7.5 years) . It is difficult to explain but it might be simply a consequence of relatively late diagnosis of neoplastic diseases in Poland, especially if asymptomatic as in the case of CLL .…”

“…Our study included 22 patients with HvRS diagnosed between 2002 and 2016 at 10 PLRG centers. Twelve patients have been reported earlier . The median age at CLL/SLL diagnosis was 59 years (range: 39‐77), only three (14%) patients were older than 70 years.…”

Epstein–Barr virus‐positive diffuse large B cell lymphoma arising from a chronic lymphocytic leukemia: Overlapping features with classical Hodgkin lymphoma

“…About 2–8 % of patients with CLL/SLL develop diffuse large B‐cell lymphoma (RT‐DLBCL), the most common type of transformation, followed by classical Hodgkin lymphoma (RT‐CHL) in <1 % patients . However, the definition is still controversial: some authors restricted the term RS only to those developing DLBCL, so‐called “true or classical RT” . RT is an aggressive disease, with a median survival of less than one year .…”

Systemic eosinophilia with skin and pulmonary infiltrates in a patient with chronic lymphocytic leukemia: A case report

“…[20,26,30,31] While different pathogenetic mechanisms are discussed in both types of transformation, only type 2 is considered as true Hodgkin transformation irrespective of clonal relationship with the underlying CLL cells. [6,20,[29][30][31][32] In our patient, morphological and immunohistochemical findings at autopsy showed classical HL, namely type 2 transformation. Approximately half of CLL cases carry a mutation in the variable region of the IGHV gene.…”

“…[20,25] Generally, clinical outcomes are worse than in de novo HL. [20,25,32] A retrospective analysis demonstrated that patients previously treated for CLL with fludarabine displayed a more aggressive course of HL and a shorter mean survival of 0.7 years compared to 2.1 years in the non-fludarabine group. [20] …”