Rapid progression to Richter’s syndrome in patient with chronic lymphocytic leukemia and near-triploid karyotype

Introduction. The presence of aneuploidy in patients with chronic lymphocytic leukemia (CLL), except trisomy 12, is quite uncommon. The frequency of hyperdiploidy or near-tetraploidy ocurrs in 1-3% of the CLL patients and usually confer poor prognosis. Case report. We report a patient in a progressive phase of CLL with near-triploid karyotype. Cytogenetic analysis was performed and complemented with molecular methods and pathohistological examination. The complex karyotype was accompanied with the TP53, C-MYC and IGH gene disruptions, the most probable cause of rapid evolution into Richter's syndrome. Conclusion. Utilization of comprehensive diagnostic techniques is highly recommended in patients with progressive phase of CLL, primarily for the adequate choice of management strategy. The current case confirms poor prognosis of the previously reported CLL patients with aneuploidy.

Isolated myeloid sarcoma of the gastrointestinal tract

Myeloid sarcoma (MS) is a rare disease that presents as an extramedullary tumor of myeloid cells. Most patients subsequently develop acute myelogenous leukemia (AML), and their prognosis is poor. Here, we report the case of a 28-year-old woman with a primary isolated myeloid sarcoma which originated in the gastrointestinal (GI) tract. Two months after initial presentation, bone marrow tests led to a diagnosis of AML. This case is noteworthy because GI tract infiltration with leukemic cells is very rare, and it is even more rare as an occurrence preceding the development of systemic leukemia.

T-cell large granular lymphocytic (T-LGL) leukemia: a single institution experience

BACKGROUND

T-cell large granular lymphocytic (T-LGL) leukemia is a rare lymphoproliferative disease which usually affects elderly people. The clinical course of T-LGL leukemia is generally indolent, with lymphocytosis and splenomegaly in 20-50% patients, hepatomegaly in 5-20% of patients, and less commonly, lymphadenopathy. T-LGL leukemia is associated with immunological abnormalities: rheumatoid factor with or without rheumatoid arthritis (RA), Coombs positive hemolytic anemia, idiopathic thrombocytopenic purpura (ITP), pure red cell aplasia (PRCA), positive anti-nuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), hypogammaglobulinemia, and polyclonal hypergammaglobulinemia. Aim To compare clinical and laboratory features of T-LGL leukemia patients and their responses to different chemotherapy regimens.

METHODS

Six patients (3 males and 3 females) with T-LGL leukemia were analyzed. The diagnosis was based on accepted morphologic criteria, immunophenotype, and polymerase chain reaction (PCR) detection of T-cell receptor (TCR) gene rearrangements.

RESULTS

All patients exhibited lymphocytosis, mainly with unusual morphologies, splenomegaly, and elevated serum lactate dehydrogenase (LDH). Three patients were treated with a Fludarabine-Cyclophosphamide (FC) combination as initial therapy while three patients received CHOP. Two patients received more than one treatment regimen. One patient died due to T-LGL leukemia in first year after diagnosis, one patient died 4 years after diagnosis, two patients interrupted their treatment, and two patients are still alive.

CONCLUSIONS

Further prospective studies are needed for establishing a gold standard therapy for T-LGL leukemia.