Persistent eosinophilia in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma and TP53 deletion is a potential predictor of variant Richter’s transformation
Keywords:
Eosinophilia, chronic lymphocytic leukemia, small lymphocytic lymphoma, classical Hodgkin lymphomaAbstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) progression to diffuse large B-cell lymphoma (Richter’s syndrome) is noted in approximately 3 - 16% of the patients. However, transformation to classical Hodgkin lymphoma occurs in only 0.5% of the patients and has no clinically well-defined predictors. We report three patients with CLL/SLL and TP53 deletion in whom persistent eosinophilia preceded the Hodgkin lymphoma transformationReferences
1. Richter MN. Generalized Reticular Cell Sarcoma of Lymph Nodes Associated with Lymphatic Leukemia. Am J Pathol. 1928 Jul; 4(4): 285–292.7.
2. Rossi D, Cerri M, Capello D, et al. Biological and clinical risk factors of chronic lymphocytic leukaemia transformation to Richter syndrome. Br J Haematol. 2008 Jun;142(2):202-15.
3. Parikh SA, Habermann TM, Chaffee KG, et al. Hodgkin transformation of chronic lymphocytic leukemia: Incidence, outcomes, and comparison to de novo Hodgkin lymphoma. Am J Hematol. 2015;90(4):334-338.
4. Parikh SA, Kay NE, Shanafelt TD. How we treat Richter syndrome. Blood. 2014;123(11):1647-1657.
5. Richter MN. Generalized Reticular Cell Sarcoma of Lymph Nodes Associated with Lymphatic Leukemia. Am J Pathol. 1928;4(4):285-292 287.
6. Krause JR, Drinkard LC, Keglovits LC. Hodgkin lymphoma transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma. Proc (Bayl Univ Med Cent). 2013;26(1):16-18.
7. Tseng D, Jones CD, Anderson M, Warnke R, Zehnder JL, Miklos DB. Clonally identical Hodgkin's disease develops after allogeneic hematopoietic cell transplant for CLL. Bone Marrow Transplant. 2011;46(12):1576-1578.
8. Vasilj A, Kojic-Katovic S, Maricevic I, et al. Hodgkin's lymphoma variant of Richter's syndrome. Coll Antropol. 2010;34(1):295-299.
9. de Leval L, Vivario M, De Prijck B, et al. Distinct clonal origin in two cases of Hodgkin's lymphoma variant of Richter's syndrome associated With EBV infection. Am J Surg Pathol. 2004;28(5):679-686.
10. Nemets A, Ben Dor D, Barry T, et al. Variant Richter's syndrome: a rare case of classical Hodgkin's lymphoma developing in a patient with chronic lymphocytic leukemia treated with fludarabine. Leukemia & lymphoma. 2003;44(12):2151-2154.
11. Tzankov A, Fong D. Hodgkin's disease variant of Richter's syndrome clonally related to chronic lymphocytic leukemia arises in ZAP-70 negative mutated CLL. Med Hypotheses. 2006;66(3):577-579.
12. Fabbri A, Cencini E, Bocchia M. Hodgkin's lymphoma as Richter's transformation in chronic lymphocytic leukemia. Med Oncol. 2014;31(4):904.
13. Kazmierczak M, Kroll-Balcerzak R, Balcerzak A, et al. Hodgkin lymphoma transformation of chronic lymphocytic leukemia: cases report and discussion. Med Oncol. 2014;31(1):800.
14. Fayad L, Robertson LE, O'Brien S, et al. Hodgkin's disease variant of Richter's syndrome: experience at a single institution. Leukemia & lymphoma. 1996;23(3-4):333-337.
15. Dujardin F, Lefrancq T, Blechet C, et al. [Hodgkin's disease variant of Richter's syndrome. Two cases and literature review]. Ann Pathol. 2008;28(4):311-316.
16. Jamroziak K, Grzybowska-Izydorczyk O, Jesionek-Kupnicka D, Gora-Tybor J, Robak T. Poor prognosis of Hodgkin variant of Richter transformation in chronic lymphocytic leukemia treated with cladribine. Br J Haematol. 2012;158(2):286-288.
17. Momose H, Jaffe ES, Shin SS, Chen YY, Weiss LM. Chronic lymphocytic leukemia/small lymphocytic lymphoma with Reed-Sternberg-like cells and possible transformation to Hodgkin's disease. Mediation by Epstein-Barr virus. Am J Surg Pathol. 1992;16(9):859-867.
18. Tadmor T, Shvidel L, Goldschmidt N, et al. Hodgkin's variant of Richter transformation in chronic lymphocytic leukemia; a retrospective study from the Israeli CLL study group. Anticancer Res. 2014;34(2):785-790.
19. Tsimberidou AM, O'Brien S, Kantarjian HM, et al. Hodgkin transformation of chronic lymphocytic leukemia: the M. D. Anderson Cancer Center experience. Cancer. 2006;107(6):1294-1302.
20. Bockorny B, Codreanu I, Dasanu CA. Hodgkin lymphoma as Richter transformation in chronic lymphocytic leukaemia: a retrospective analysis of world literature. Br J Haematol. 2012;156(1):50-66.
21. Rabe KG, Ding W, Call TG, et al. Hodgkin Transformation Of Chronic Lymphocytic Leukemia (CLL): Mayo Clinic Experience. Blood. 2013;122(21):1642-1642.
22. Rossi D, Spina V, Deambrogi C, et al. The genetics of Richter syndrome reveals disease heterogeneity and predicts survival after transformation. Blood. 2011;117(12):3391-3401.
23. Ohno T, Smir BN, Weisenburger DD, Gascoyne RD, Hinrichs SD, Chan WC. Origin of the Hodgkin/Reed-Sternberg cells in chronic lymphocytic leukemia with "Hodgkin's transformation". Blood. 1998;91(5):1757-1761.
24. van den Berg A, Maggio E, Rust R, Kooistra K, Diepstra A, Poppema S. Clonal relation in a case of CLL, ALCL, and Hodgkin composite lymphoma. Blood. 2002;100(4):1425-1429.
25. Shin SS, Ben-Ezra J, Burke JS, Sheibani K, Rappaport H. Reed-Sternberg-like cells in low-grade lymphomas are transformed neoplastic cells of B-cell lineage. Am J Clin Pathol. 1993;99(6):658-662.
26. Pescarmona E, Pignoloni P, Mauro FR, et al. Hodgkin/Reed-Sternberg cells and Hodgkin's disease in patients with B-cell chronic lymphocytic leukaemia: an immunohistological, molecular and clinical study of four cases suggesting a heterogeneous pathogenetic background. Virchows Arch. 2000;437(2):129-132.
27. Isikdogan A, Ayyildiz O, Buyukbayram H, Muftuoglu E. Hodgkin's disease variant of Richter's transformation: a case report. Med Oncol. 2002;19(2):109-112.
28. Nagy V, Dommann-Scherrer, Tzankov A, Pless M. Systemic eosinophilia with skin and pulmonary infiltrates in a patient with chronic lymphocytic leukemia: A case report. Case Reports in CLinical Pathology. 2016;3(2):15-21.
29. Rossi D, Cerri M, Capello D, et al. Biological and clinical risk factors of chronic lymphocytic leukaemia transformation to Richter syndrome. Br J Haematol. 2008;142(2):202-215.
30. Vaughan Hudson B, Linch DC, Macintyre EA, et al. Selective peripheral blood eosinophilia associated with survival advantage in Hodgkin's disease (BNLI Report No 31). British National Lymphoma Investigation. J Clin Pathol. 1987;40(3):247-250.
31. Desenne JJ, Acquatella Stern R, Muller A, Sanchez M, Somoza R. Blood eosinophilia in Hodgkin’s disease: a follow up of 25 cases in Venezuela. Cancer 1992; 69:1248
32. Roufosse F, Garaud S, de Leval L. Lymphoproliferative disorders associated with hypereosinophilia. Semin Hematol. 2012;49(2):138-148.
33. Koeffler HP, Levine AM, Sparkes M, Sparkes RS. Chronic myelocytic leukemia: eosinophils involved in the malignant clone. Blood. 1980;55(6):1063-1065.
34. Swerdlow SH, Campo E, Harris NL, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition. World Health Organization; 2008.
35. Andersen CL, Siersma VD, Hasselbalch HC, et al. Eosinophilia in routine blood samples and the subsequent risk of hematological malignancies and death. Am J Hematol. 2013;88(10):843-847.
36. Larfars G, Uden-Blohme AM, Samuelsson J. Fludarabine, as well as 2-chlorodeoxyadenosine, can induce eosinophilia during treatment of lymphoid malignancies. Br J Haematol. 1996;94(4):709-712.
37. Sezer O, Schmid P, Hallek M, et al. Eosinophilia during fludarabine treatment of chronic lymphocytic leukemia. Ann Hematol. 1999;78(10):475-477.
38. Voutsadakis IA. Fludarabine-induced eosinophilia: case report. Ann Hematol. 2002;81(5):292-293.
39. Bockorny B, Codreanu I and Dasanu CA: Hodgkin lymphoma as Richter transformation in chronic lymphocytic leukaemia: A retrospective analysis of world literature. Br J Haematol 2012;156: 50-66.
40. Dasanu CA: Intrinsic and treatment-related immune alterations in chronic lymphocytic leukaemia and their impact for clinical practice. Expert Opin Pharmacother 2008;9: 1481-1494.
41. Rubin D, Hudnall SD, Aisenberg A, Jacobson JO, Harris NL. Richter's transformation of chronic lymphocytic leukemia with Hodgkin's-like cells is associated with Epstein-Barr virus infection. Mod Pathol. 1994;7(1):91-98.
42. Dolcetti R, Carbone A. Epstein-Barr virus infection and chronic lymphocytic leukemia: a possible progression factor? Infect Agent Cancer. 2010;5:22.
2. Rossi D, Cerri M, Capello D, et al. Biological and clinical risk factors of chronic lymphocytic leukaemia transformation to Richter syndrome. Br J Haematol. 2008 Jun;142(2):202-15.
3. Parikh SA, Habermann TM, Chaffee KG, et al. Hodgkin transformation of chronic lymphocytic leukemia: Incidence, outcomes, and comparison to de novo Hodgkin lymphoma. Am J Hematol. 2015;90(4):334-338.
4. Parikh SA, Kay NE, Shanafelt TD. How we treat Richter syndrome. Blood. 2014;123(11):1647-1657.
5. Richter MN. Generalized Reticular Cell Sarcoma of Lymph Nodes Associated with Lymphatic Leukemia. Am J Pathol. 1928;4(4):285-292 287.
6. Krause JR, Drinkard LC, Keglovits LC. Hodgkin lymphoma transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma. Proc (Bayl Univ Med Cent). 2013;26(1):16-18.
7. Tseng D, Jones CD, Anderson M, Warnke R, Zehnder JL, Miklos DB. Clonally identical Hodgkin's disease develops after allogeneic hematopoietic cell transplant for CLL. Bone Marrow Transplant. 2011;46(12):1576-1578.
8. Vasilj A, Kojic-Katovic S, Maricevic I, et al. Hodgkin's lymphoma variant of Richter's syndrome. Coll Antropol. 2010;34(1):295-299.
9. de Leval L, Vivario M, De Prijck B, et al. Distinct clonal origin in two cases of Hodgkin's lymphoma variant of Richter's syndrome associated With EBV infection. Am J Surg Pathol. 2004;28(5):679-686.
10. Nemets A, Ben Dor D, Barry T, et al. Variant Richter's syndrome: a rare case of classical Hodgkin's lymphoma developing in a patient with chronic lymphocytic leukemia treated with fludarabine. Leukemia & lymphoma. 2003;44(12):2151-2154.
11. Tzankov A, Fong D. Hodgkin's disease variant of Richter's syndrome clonally related to chronic lymphocytic leukemia arises in ZAP-70 negative mutated CLL. Med Hypotheses. 2006;66(3):577-579.
12. Fabbri A, Cencini E, Bocchia M. Hodgkin's lymphoma as Richter's transformation in chronic lymphocytic leukemia. Med Oncol. 2014;31(4):904.
13. Kazmierczak M, Kroll-Balcerzak R, Balcerzak A, et al. Hodgkin lymphoma transformation of chronic lymphocytic leukemia: cases report and discussion. Med Oncol. 2014;31(1):800.
14. Fayad L, Robertson LE, O'Brien S, et al. Hodgkin's disease variant of Richter's syndrome: experience at a single institution. Leukemia & lymphoma. 1996;23(3-4):333-337.
15. Dujardin F, Lefrancq T, Blechet C, et al. [Hodgkin's disease variant of Richter's syndrome. Two cases and literature review]. Ann Pathol. 2008;28(4):311-316.
16. Jamroziak K, Grzybowska-Izydorczyk O, Jesionek-Kupnicka D, Gora-Tybor J, Robak T. Poor prognosis of Hodgkin variant of Richter transformation in chronic lymphocytic leukemia treated with cladribine. Br J Haematol. 2012;158(2):286-288.
17. Momose H, Jaffe ES, Shin SS, Chen YY, Weiss LM. Chronic lymphocytic leukemia/small lymphocytic lymphoma with Reed-Sternberg-like cells and possible transformation to Hodgkin's disease. Mediation by Epstein-Barr virus. Am J Surg Pathol. 1992;16(9):859-867.
18. Tadmor T, Shvidel L, Goldschmidt N, et al. Hodgkin's variant of Richter transformation in chronic lymphocytic leukemia; a retrospective study from the Israeli CLL study group. Anticancer Res. 2014;34(2):785-790.
19. Tsimberidou AM, O'Brien S, Kantarjian HM, et al. Hodgkin transformation of chronic lymphocytic leukemia: the M. D. Anderson Cancer Center experience. Cancer. 2006;107(6):1294-1302.
20. Bockorny B, Codreanu I, Dasanu CA. Hodgkin lymphoma as Richter transformation in chronic lymphocytic leukaemia: a retrospective analysis of world literature. Br J Haematol. 2012;156(1):50-66.
21. Rabe KG, Ding W, Call TG, et al. Hodgkin Transformation Of Chronic Lymphocytic Leukemia (CLL): Mayo Clinic Experience. Blood. 2013;122(21):1642-1642.
22. Rossi D, Spina V, Deambrogi C, et al. The genetics of Richter syndrome reveals disease heterogeneity and predicts survival after transformation. Blood. 2011;117(12):3391-3401.
23. Ohno T, Smir BN, Weisenburger DD, Gascoyne RD, Hinrichs SD, Chan WC. Origin of the Hodgkin/Reed-Sternberg cells in chronic lymphocytic leukemia with "Hodgkin's transformation". Blood. 1998;91(5):1757-1761.
24. van den Berg A, Maggio E, Rust R, Kooistra K, Diepstra A, Poppema S. Clonal relation in a case of CLL, ALCL, and Hodgkin composite lymphoma. Blood. 2002;100(4):1425-1429.
25. Shin SS, Ben-Ezra J, Burke JS, Sheibani K, Rappaport H. Reed-Sternberg-like cells in low-grade lymphomas are transformed neoplastic cells of B-cell lineage. Am J Clin Pathol. 1993;99(6):658-662.
26. Pescarmona E, Pignoloni P, Mauro FR, et al. Hodgkin/Reed-Sternberg cells and Hodgkin's disease in patients with B-cell chronic lymphocytic leukaemia: an immunohistological, molecular and clinical study of four cases suggesting a heterogeneous pathogenetic background. Virchows Arch. 2000;437(2):129-132.
27. Isikdogan A, Ayyildiz O, Buyukbayram H, Muftuoglu E. Hodgkin's disease variant of Richter's transformation: a case report. Med Oncol. 2002;19(2):109-112.
28. Nagy V, Dommann-Scherrer, Tzankov A, Pless M. Systemic eosinophilia with skin and pulmonary infiltrates in a patient with chronic lymphocytic leukemia: A case report. Case Reports in CLinical Pathology. 2016;3(2):15-21.
29. Rossi D, Cerri M, Capello D, et al. Biological and clinical risk factors of chronic lymphocytic leukaemia transformation to Richter syndrome. Br J Haematol. 2008;142(2):202-215.
30. Vaughan Hudson B, Linch DC, Macintyre EA, et al. Selective peripheral blood eosinophilia associated with survival advantage in Hodgkin's disease (BNLI Report No 31). British National Lymphoma Investigation. J Clin Pathol. 1987;40(3):247-250.
31. Desenne JJ, Acquatella Stern R, Muller A, Sanchez M, Somoza R. Blood eosinophilia in Hodgkin’s disease: a follow up of 25 cases in Venezuela. Cancer 1992; 69:1248
32. Roufosse F, Garaud S, de Leval L. Lymphoproliferative disorders associated with hypereosinophilia. Semin Hematol. 2012;49(2):138-148.
33. Koeffler HP, Levine AM, Sparkes M, Sparkes RS. Chronic myelocytic leukemia: eosinophils involved in the malignant clone. Blood. 1980;55(6):1063-1065.
34. Swerdlow SH, Campo E, Harris NL, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, Fourth Edition. World Health Organization; 2008.
35. Andersen CL, Siersma VD, Hasselbalch HC, et al. Eosinophilia in routine blood samples and the subsequent risk of hematological malignancies and death. Am J Hematol. 2013;88(10):843-847.
36. Larfars G, Uden-Blohme AM, Samuelsson J. Fludarabine, as well as 2-chlorodeoxyadenosine, can induce eosinophilia during treatment of lymphoid malignancies. Br J Haematol. 1996;94(4):709-712.
37. Sezer O, Schmid P, Hallek M, et al. Eosinophilia during fludarabine treatment of chronic lymphocytic leukemia. Ann Hematol. 1999;78(10):475-477.
38. Voutsadakis IA. Fludarabine-induced eosinophilia: case report. Ann Hematol. 2002;81(5):292-293.
39. Bockorny B, Codreanu I and Dasanu CA: Hodgkin lymphoma as Richter transformation in chronic lymphocytic leukaemia: A retrospective analysis of world literature. Br J Haematol 2012;156: 50-66.
40. Dasanu CA: Intrinsic and treatment-related immune alterations in chronic lymphocytic leukaemia and their impact for clinical practice. Expert Opin Pharmacother 2008;9: 1481-1494.
41. Rubin D, Hudnall SD, Aisenberg A, Jacobson JO, Harris NL. Richter's transformation of chronic lymphocytic leukemia with Hodgkin's-like cells is associated with Epstein-Barr virus infection. Mod Pathol. 1994;7(1):91-98.
42. Dolcetti R, Carbone A. Epstein-Barr virus infection and chronic lymphocytic leukemia: a possible progression factor? Infect Agent Cancer. 2010;5:22.
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Ouseph MM, Butera JN, Griffith RC, Stachurski D, Treaba DO. Persistent eosinophilia in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma and TP53 deletion is a potential predictor of variant Richter’s transformation. Ann of Pathol and Lab Med [Internet]. 2016 Oct. 3 [cited 2025 Feb. 6];3(4):C212-216. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm994
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Copyright (c) 2016 Madhu M Ouseph, James N Butera, Rogers C Griffith, Dariusz Stachurski, Diana Olguta Treaba
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