Peripheral T-cell Lymphomas With Cytotoxic Phenotype in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Abstract

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is relatively common, and patients occasionally develop other neoplasms; however, patients who develop other types of lymphomas are rare. We encountered 3 patients with CLL/SLL (one 59-y-old man and 2 women aged 56 and 66 y) who developed T-cell lymphomas. Both women developed ALK anaplastic large cell lymphomas (ALCLs), whereas the man developed CD8 peripheral T-cell lymphoma, not otherwise specified. All 3 T-cell lymphomas expressed granzyme B and perforin, indicating a cytotoxic immunophenotype. In 1 case, the first presentation was a lymph nodal composite lymphoma. In the other 2 cases, the T-cell lymphomas arose <1 year after the diagnosis of CLL/SLL and were identified in a lymph node in one case and in the spleen in the other. The patient with a composite lymphoma (SLL/ALK ALCL) was treated and was free of disease at last follow-up, whereas the other 2 patients succumbed to their disease, 1 month and 7 months after the diagnosis of T-cell lymphoma. Peripheral T-cell lymphomas rarely occur in CLL/SLL patients. On the basis of our small series, those with a cytotoxic phenotype appear to be more common in this setting. The occurrence of ALK ALCL in 2 older patients was especially surprising and suggested that CLL/SLL may have played a role in the development of ALCL.

Development of T-cell large granular lymphocytic leukemia in the course of B-cell chronic lymphocytic leukemia with a causal relationship inferred from a flow cytometric analysis of the bone marrow aspirate

“…This is in agreement with authors who observed a development of peripheral T-cell lymphomas with cytotoxic phenotype in the patients with B-CLL [9,10].…”

“…Large granular lymphocytic leukemia is the doi: 10.7243/2052-7896-3-4 clonal expansion of either CD8 positive cytotoxic T-cells (80%) or natural killer cells (20%). Normal number of LGL (morphology is depicted in Figure 1) in the peripheral blood is 100 to 300 LGL/microliter (µL) (0.1-0.3X10 9 LGL/L) or 5% to 15% of peripheral blood lymphocytes. According to the immunophenotype, LGL are divided in two types of cells: CD8 and CD3 positive suppressor/cytotoxic T-cells and natural killer cells (CD3 negative, CD16 positive LGL).…”

Composite Lymphoma as Co-occurrence of Advanced Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Carrying Trisomy 12 and t(14;18) and Peripheral T-cell Lymphoma

“…2 In the present patient, R-CHOP continued to be effective against advanced B-CLL, whereas the anti-CD30 antibody exhibited transient effects on PTCL. Previous studies demonstrated the efficacy of autologous or allogeneic hematopoietic stem cell transplantation (HSCT) for composite lymphoma during remission.…”

“…Among these T-cell lymphomas, 9 cases of PTCL-NOS have been reported, followed by 4 cases of ALCL. 2 These reports documented that the time from the onset of B-CLL to lymphoma development was 0.8 to 14 years, with a survival time of 2 days to 2 years after the diagnosis of composite lymphoma. Thus, composite lymphoma occurs even in the early stage of B-CLL.…”

“…3 EpsteinBarr virus (EBV) was negative in all 17 reported cases examined. 2 In 10% of B-CLL cases, leukemic lymphocytes change from a typical small mature form to lymphocytes with prominent nucleoli. 4 This change is known as transformation to prolymphocytes, and in the FAB classification, it is defined as CLL/prolymphocytic leukemia (PLL) when the percentage of prolymphocytes is 10% or more and less than 55%.…”