title: Concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine: a dimorphic presentation of iatrogenic immunodeficiency-associated lymphoproliferative disorder with evidence suggestive of multiclonal transformability of B cells by Epstein-Barr virus.
abstract: A small fraction of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma develop Epstein-Barr virus-positive B-cell lymphoproliferative disorders. These Epstein-Barr virus-B-cell lymphoproliferative disorders are thought to be related to immune suppression induced by fludarabine/other chemotherapeutic regimens. As in other immunodeficiency-associated lymphoproliferative disorders, these disorders demonstrate a heterogeneous histological spectrum that ranges from polymorphic to monomorphic to classical Hodgkin lymphoma-like lesions. We report a case of concurrent classical Hodgkin lymphoma and plasmablastic lymphoma in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma treated with fludarabine. Both classical Hodgkin lymphoma and plasmablastic lymphoma were positive for Epstein-Barr virus-encoded RNA, whereas classical Hodgkin lymphoma was also positive for Epstein-Barr virus- latent membrane protein 1, suggesting a different viral latency. Immunoglobulin gene rearrangement studies demonstrated distinct clones in the plasmablastic lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma. These findings suggest biclonal secondary lymphomas associated with iatrogenic immunodeficiency. Epstein-Barr virus-B-cell lymphoproliferative disorders in the setting of chronic lymphocytic leukemia/small lymphocytic lymphoma, in particular those arising after chemotherapy, should be separated from true Richter's transformation, and be categorized as (iatrogenic) immunodeficiency-associated lymphoproliferative disorder.
authors.affiliation: Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Foo
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
authors.forename: Siby
authors.initials: S
authors.lastname: Sebastian
authors.forename: Charles B
authors.initials: CB
authors.lastname: Hutchinson
authors.forename: Jim
authors.initials: J
authors.lastname: Burchette
authors.forename: Endi
authors.initials: E
authors.lastname: Wang
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001402:B-Lymphocytes / Q000473:pathology; D002471:Cell Transformation, Neoplastic; D002999:Clone Cells; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy / Q000473:pathology*; D017809:Fatal Outcome; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000188:drug therapy / Q000473:pathology / Q000821:virology; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D008297:Male; D009378:Neoplasms, Multiple Primary; D010950:Plasma Cells / Q000473:pathology; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine