title: Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion.
abstract: 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.
authors.affiliation: Servicio de Hematología Clinica, Institut Catalá d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Español
authors.forename: T
authors.initials: T
authors.lastname: Büchler
authors.forename: C
authors.initials: C
authors.lastname: Ferrá
authors.forename: D
authors.initials: D
authors.lastname: Gallardo
authors.forename: P
authors.initials: P
authors.lastname: Reyes
authors.forename: J
authors.initials: J
authors.lastname: Sarrá
authors.forename: A
authors.initials: A
authors.lastname: Domingo
authors.forename: V
authors.initials: V
authors.lastname: Romagosa
authors.forename: A
authors.initials: A
authors.lastname: Grañena
mesh_terms: 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