Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion.
Development of high-grade non-Hodgkin's lymphoma is a possible complication of chronic lymphocytic leukaemia/small lymphocytic lymphoma, known as Richter's syndrome (RS). Treatment for RS includes systemic chemotherapy and, recently, allogeneic stem cell transplantation (SCT). We describe a patient with B-chronic lymphocytic leukaemia who developed RS 4 months after allogeneic SCT from an HLA-identical sibling. The RS presented with systemic symptoms, lymphadenopathy, pancytopenia and serum lactate dehydrogenase elevation. The patient was treated with immunosuppressive drug withdrawal and a donor lymphocyte infusion (DLI) of 1 x 10(7) CD3/kg, leading to the disappearance of all symptoms and the attainment of complete donor chimerism. After 18 months of the therapeutic DLI, the patient continues in complete remission.
Español
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Servicio de Hematología Clinica, Institut Catalá d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.
Büchler
T
T
Ferrá
C
C
Gallardo
D
D
Reyes
P
P
Sarrá
J
J
Domingo
A
A
Romagosa
V
V
Grañena
A
A
D004912:Erythrocytes / Q000473:pathology; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000473:pathology / Q000628:therapy*; D017710:Lymphocyte Transfusion; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology*; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D013997:Time Factors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous / Q000276:immunology