|Table of Contents|

Histologic transformation from follicular lymphoma to B-lymphoblastic leukemia and diffuse large B-cell lymphoma:A case report and literature review

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 17
Page:
3248-3252
Research Field:
Publishing date:

Info

Title:
Histologic transformation from follicular lymphoma to B-lymphoblastic leukemia and diffuse large B-cell lymphoma:A case report and literature review
Author(s):
YU Min; HUANG Mengzhen; XU Shan; KONG Fancong; LI Fei
The First Affiliated Hospital of Nanchang University,Jiangxi Nanchang 330006,China.
Keywords:
follicular lymphoma; histologic transformation; chimeric antigen receptor-T cell therapy
PACS:
R733.4
DOI:
10.3969/j.issn.1672-4992.2023.17.019
Abstract:
Objective:We presented a rare clinical case of follicular lymphoma(FL),which sequentially transformed into B-lymphoblastic leukemia(B-ALL) and diffuse large B-cell lymphoma(DLBCL),with the aim of raising the awareness of the rare occurrence of transformation and providing clinical experience for treatment.Methods:The clinical process of diagnosis and treatment of this patient were retrospectively analyzed.The related literature of PubMed and CNKI were searched and reviewed.Results:The patient was a 47-year-old male diagnosed with FL,grade 2 stage IV,based on an excisional biopsy of en enlarged right inguinal lymph node.He was given BR(rituximab,bendamustine) regimen and achieved complete remission(CR) after 6 cycles of treatment.He transformed into B-ALL roughly 6 months after the initial diagnosis.In our case,the patient was successfully treated with CD19-targed chimeric antigen receptor modified T-cell(CAR-T) therapy and maintained disease-free survival within the following year,until progressed with a abdominal mass diagnosed with DLBCL.Cytogenetically,an identical t(14;18) translocation was shared by FL,B-ALL and DLBCL tissues,indicating a clonal relationship between the three type of lymphoma cells.Of note,a MYC gene translocation was specific to the B-ALL stage,together with a marked mutational profile,may have contributed to the lymphoblastic transformation of FL.Transformation of FL into B-lymphoblastic lymphoma/leukemiais rare and approximately 25 similar cases have been reported previously in literature.The MYC translocation is reported in almost all similar cases and likely is crucial in the pathogenesis of the lymphoblastic transformation.Patients with this type of translocation usually have a poor prognosis,and no standard therapy has been established.Conclusion:This case report highlights the possible transformation of FL into precursor B-lymphoblastic lymphoma/leukemia,in which acquisition of MYC gene rearrangement is a critical event.Similar cases should be accumulated and analyzed carefully.CAR-T therapy might be a safe and effective approach,despite further strategies are needed to achieve a durable CR.

References:

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Memo

Memo:
National Natural Science Foundation of China（No.81960041）;国家自然科学基金地区项目（编号：81960041）；中央引导地方科技发展专项-国家血液系统疾病临床医学研究中心江西分中心（编号：20211ZDG02006）；江西省重点研发计划一般项目（编号：202003BBGL73199）；江西省血液病临床医学研究中心（编号：20212BCG74001）
Last Update: 2023-07-31