Leukemic diffuse large B-cell lymphoma in a patient with myeloproliferative disorder.
Essential thrombocythemia is well-known to transform to other myeloid disorders, such as leukemia; however, the risk for development of lymphoma is not as well studied. This case report discusses a 76-year-old man with a history of prefibrotic post-essential thrombocythemia myelofibrosis on ruxolitinib, who developed anemia, thrombocytopenia, and leukocytosis with peripheral blasts. Results of a bone marrow biopsy and PET and CT scans revealed stage IV leukemic diffuse large B-cell lymphoma. Several days after cessation of ruxolitinib, the patient developed fevers, hypotension, and low-grade disseminated intravascular coagulation, and subsequently developed spontaneous tumor lysis syndrome, which resulted in death. This case is unique in several aspects: it highlights the rare possibility of lymphomatous transformation of myeloproliferative disorders, an unusual presentation of lymphoma masquerading as leukemia, and the possibility of ruxolitinib withdrawal syndrome. Additionally, this case serves as a reminder that the use of novel therapies should be adopted after a thorough assessment of long-term risks, including those associated with abrupt withdrawal.
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Vijaya Raj
VR
Bhatt
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
R Gregory
RG
Bociek
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Ji
J
Yuan
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Kai
K
Fu
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Timothy C
TC
Greiner
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Bhavana J
BJ
Dave
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
Sandeep K
SK
Rajan
From the Department of Internal Medicine, Division of Hematology-Oncology; Department of Pathology and Microbiology; and Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska.
James O
JO
Armitage
D000368:Aged; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D016130:Immunophenotyping; D008214:Lymphocytes / Q000378:metabolism / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D009196:Myeloproliferative Disorders / Q000150:complications* / Q000175:diagnosis; D049268:Positron-Emission Tomography; D055728:Primary Myelofibrosis / Q000150:complications; D013920:Thrombocythemia, Essential / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed