title: Large-cell transformation of chronic lymphocytic leukemia and follicular lymphoma during or soon after treatment with fludarabine-rituximab-containing regimens: natural history- or therapy-related complication?
abstract: Novel therapeutic regimens containing purine analogs and monoclonal antibodies have led to significant improvement in the course of indolent lymphoproliferative diseases (LPD). Complete clinical and even molecular remissions have been achieved in an increasing proportion of patients. In parallel to their tumor cytotoxic effect, these agents are inevitably associated with prolonged immunosuppression inherent to their mechanism of antilymphocytic activity. Until now, attention has been paid mainly to opportunistic infection occurring as a result of the above drug-induced immunosuppression and less to other possible complications, such as malignancy or tumor progression in the immunocompromised host. Here we briefly report nine patients with previously treated indolent LPD in whom the onset of large-cell transformation occurred during or shortly after the initiation of regimens containing these agents before transformation occurred. One patient had received rituximab alone, three fludarabine-containing regimens and five received sequential regimens containing both agents. This
authors.affiliation: Department of Hematology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Cohen
authors.forename: Nael
authors.initials: N
authors.lastname: Da'as
authors.forename: Diana
authors.initials: D
authors.lastname: Libster
authors.forename: Gail
authors.initials: G
authors.lastname: Amir
authors.forename: Alan
authors.initials: A
authors.lastname: Berrebi
authors.forename: Aaron
authors.initials: A
authors.lastname: Polliack
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002471:Cell Transformation, Neoplastic; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008224:Lymphoma, Follicular / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000209:etiology*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology; D000069283:Rituximab; D013997:Time Factors; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine