Follicular lymphoma transformation to dual translocated Burkitt-like lymphoma: improved disease control associated with radiation therapy.
Dual translocated (or "dual hit") lymphomas are highly aggressive B cell neoplasms associated with an extremely poor prognosis. The optimal treatment for these lymphomas remains undefined. We present two cases of follicular lymphoma with transformation to Burkitt-like lymphoma. In both cases dual translocations involving both the bcl-2 and c-myc loci were present. Each patient underwent intensive induction immunochemotherapy followed by autologous stem cell transplantation and radiation therapy. The first patient received post-transplant mediastinal radiation and developed recurrence in multiple areas outside of the radiation field. The second patient received total body irradiation as part of the conditioning regimen, and is without recurrence 18 months after transplant, and 24 months after diagnosis of the dual translocated lymphoma. We review dual translocation B cell lymphoma in the setting of transformation from follicular lymphoma, and suggest a potential role for total body irradiation in the management of this highly aggressive non-Hodgkin lymphoma.
Parker
Stacey M
SM
Department of Internal Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA.
Olteanu
Horatiu
H
Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, USA.
VanTuinen
Peter
P
Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, USA.
Lawton
Colleen A
CA
Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA.
Schultz
Christopher J
CJ
Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA.
Christians
Kathleen K
KK
Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA.
Fenske
Timothy S
TS
Division of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA. tfenske@mcw.edu.
D002051:Burkitt Lymphoma / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D002471:Cell Transformation, Neoplastic; D006801:Humans; D008224:Lymphoma, Follicular / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019253:Proto-Oncogene Proteins c-bcl-2; D016271:Proto-Oncogene Proteins c-myc; D014916:Whole-Body Irradiation
C489427:MYC protein, human; D019253:Proto-Oncogene Proteins c-bcl-2; D016271:Proto-Oncogene Proteins c-myc