title: Early detection of Richter's transformation: stable disease with dose-reduced gemcitabine and local radiation.
abstract: BACKGROUND
  The occurrence of Hodgkin's lymphoma (HL) as a second aggressive lymphoid malignancy (known as Hodgkin's disease variant of Richter's transformation) is rarely observed. Response rates, even with highly aggressive therapy such as stem cell transplantation, are limited, ranging from 4 to 43%, and the medium survival time ranges from 5 to 8 months.
  
  
  METHODS
  A 72-year-old patient with a history of chronic lymphatic leukemia (CLL) was admitted with thoracic back pain and assumed progression of the CLL. The patient showed no fever, night sweats or weight loss. A computed tomography (CT) scan confirmed the progression of axillary and cervical lymph nodes. In addition, an intraspinal infiltration at the 8th thoracic vertebra (Th8) was detected. Surprisingly, histology of an extirpated lymph node demonstrated the existence of 2 tumors in the same lymph node. Infiltrates of small lymphocytes representing the pre-existing CLL (CD5-, CD20-, CD23-positive) coexisted with Reed-Sternberg Hodgkin's cells (CD30-, CD15-positive). Chemotherapy was started, combined with palliative radiation of vertebrae Th7-Th10. 12 months after diagnosis of Richter's transformation the patient is still alive without any progression of the underlying disease.
  
  
  CONCLUSIONS
  We present a unique case of a Hodgkin's disease variant of Richter's transformation and CLL in the same lymph node, which was detected early because of spinal infiltration and was subsequently stabilized with reduced-dosage gemcitabine and local radiation. Additionally, we show unique pictures of 2 tumors coexisting in the same lymph node.
authors.affiliation: Department of Internal Medicine, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Hueber
authors.forename: Stefan
authors.initials: S
authors.lastname: Kallert
authors.forename: Thomas
authors.initials: T
authors.lastname: Aigner
authors.forename: Wolf
authors.initials: W
authors.lastname: Rösler
authors.forename: Jochen R
authors.initials: JR
authors.lastname: Kalden
authors.forename: Hendrik
authors.initials: H
authors.lastname: Schulze-Koops
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rech
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000532:radiotherapy*; D006801:Humans; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D000093542:Gemcitabine