Successful treatment of a patient with chronic lymphocytic leukaemia (CLL) presenting with bony metastases with aggressive antibody and chemotherapy

Abstract

Osteolytic lesions are rare in chronic lymphocytic leukaemia (CLL) and thought to result from Richter's transformation or metastatic disease from nonlymphoid malignancies. We report a patient who presented with a large femoral metastatic lesion and hypercalcaemia caused by CLL itself. Complete remission of CLL with resolution of the osteolytic lesion was achieved with rituximab and cyclophosphamide, adriamycin, oncovin and prednisolone [CHOP (R-CHOP)] combination chemotherapy.

A rare case of appendicular skeleton localization in a patient with chronic lymphocytic leukemia successfully treated with salvage radiation therapy

“… 8 The lack of evidence for this rare condition became clear after a search of the English-language literature produced only sporadic case reports. Unlike the few reports we found in the English-language literature, 2 , 3 , 4 , 5 , 6 , 7 , 8 our patient did not show any sign of hypercalcemia and the anatomical features of the bone lesion were typical not of a pure osteolytic lesion, but of an endomedullary permeative lesion with periostium flogistic involvement. It is also a peculiar event because its distal appendicular skeleton location is a rare eventuality that is described mainly at the axial level.…”

“…As described by Narayan et al 7 in their case report, chemotherapy with or without radiation therapy consolidation appears to be the most reasonable option for these patients, considering the similarity to other lymphoproliferative disorders such as lymphoma or multiple myeloma. Chemotherapy also underlines the need for systemic control of possible undetectable disease.…”

“…Among them, 7 with therapeutic options of CLL bone metastases were selected. 2 , 3 , 4 , 5 , 6 , 7 , 8 Interestingly, none of the papers included ionizing radiation as a therapeutic option for this condition.…”

The Risk of Misdiagnosing the Primary Site Responsible for Bone Metastases in Patients With Chronic Lymphocytic Leukemia and a Second Primary Carcinoma

“…Patients presenting with solitary bone metastasis in the presence of CLL warrant a meticulous workup including a biopsy to precisely identify the responsible primary source. CLL is rarely the cause of metastatic bone lesions; such lesions in the context of CLL are believed to result from either Richter’s transformation or metastasis from another primary malignancy [ 5 ]. Furthermore, Richter’s transformation represents a change in the nature of the malignancy; it is characterized by the new onset of high-grade non-Hodgkin’s lymphoma in a patient with CLL [ 6 ].…”

Why R‐CHOP for first line treatment of chronic lymphocytic leukemia?

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Sir, I read with interest the article by Narayan et al 'Successful treatment of a patient with chronic lymphocytic leukemia (CLL) presenting with bony metastases with aggressive antibody and chemotherapy' published in December issue of Clinical and Laboratory Haematology (Narayan et al, 2005). It is indeed an interesting case report and I congratulate the authors for the successful treatment.

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