The clinical significance of large cells in bone marrow in patients with chronic lymphocytic leukemia

Abstract

BACKGROUNDPatients with chronic lymphocytic leukemia (CLL) that transforms to Richter syndrome (RS) frequently show atypical lymphocytes in bone marrow; however, a diagnosis of RS requires confirmation of the presence of sheets of large cells in bone marrow or lymph nodes.METHODSIn this study, the authors evaluated the clinical significance of scattered large cells in bone marrow. They assessed the possibility of predicting transformation to RS in bone marrow smears by counting the percentages of prolymphocytes and large cells in 78 patients with CLL and 29 patients with lymph node biopsy‐confirmed RS.RESULTSThe percentage of large cells was found to be correlated with decreasing survival in a continuous fashion (P = 0.006). It is interesting to note that patients who had > 7% large cells in the bone marrow and elevated β2‐microglobulin (β2‐M) levels (> 5 mg/L) had a survival duration identical to that of patients with RS, and these factors together were a strong predictor of RS (P < 0.001).CONCLUSIONSPatients with CLL who had bone marrow that contained > 7% large cells and who had β2‐M levels > 5 mg/L had a disease that was similar to RS, and the combination of large cells and β2‐M can be used as a surrogate marker for RS. Cancer 2004. © 2004 American Cancer Society.

Chronic Lymphocytic Leukemia

“…Richter's transformation, the conversion to a more aggressive, rapidly proliferating lymphoma, is seen more frequently in patients with increasing numbers of prolymphocytes. 7 Both findings establish a link between cell proliferation and clinical outcome.…”

Richter's transformation presenting as splenic rupture after 6 years of complete remission of chronic lymphocytic leukaemia

“…For initial evaluation, radiological imaging with 18 F-FDG PET/CT ( 18 F-2-deoxy-2-fluoro-d-glucose-labelled positron emission tomography) has a high sensitivity and a high negative predictive value in detecting Richter's transformation 11. One study shows that bone marrow biopsy showing a combination of large cells and β(2)-M can be used for the diagnosis of Richter's transformation 12. Biopsy with pathological differentiation remains the gold standard for the diagnosis of Richter's transformation.…”

Richter transformation of CLL

“…Accelerated CLL: this term is used in reference to the histologic findings (expanded proliferation centers without histologically proven DLBCL) in patients with CLL [49,[52][53][54]. Limited information is available regarding molecular pathogenesis of this entity.…”