Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Type of Treatment Can Effect on Transformation of Chronic Lymphocytic Leukaemia to Diffuse Large B-cell Lymphoma: A Rare Case with Review of Literature

Mehrdad Payandeh, Masoud Sadeghi*, Edris Sadeghi, Seyed Hamid Madani

Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

Abstract: Richter transformation is defined as a diffuse large cell lymphoma, occurring by transformation of chronic lymphocytic leukemia (CLL) and diffuse large B-cell lymphoma (DLBCL) is the most common type of richter syndrome. Herein, we describe report of a 51 year-old man in western Iran that referred to Hematology Clinic with complaint of three months of weight loss and sweating with generalized abdominal lymphadenopathy and the Bulky cervical lymph node. Pathology’s specimens for him demonstrated CLL in the patient (Rai system stage 4) and during seven years ago, he was treated with fludarabine and cyclophosphamide regiment for 6 courses. Cervical biopsy pathology reported a new diagnosis of diffuse large B-Cell lymphoma and also immunohistochemistry (IHC) analysis showed CD3, CD20, CD45 were positive and Bcl-2 was negative and so he was treated with new regiment of R-CHOP for 6 courses. One month after last course of chemotherapy, Cerebrospinal fluid cytology was positive with lymphomatous involvement, and also brain CT SCAN showed parenchymal involvement and therapy with high dose Methotrexate began for him. The result is that specialists should be careful that probably fludarabin therapy alone or combination it with other drug especially cyclophosphamide can effect on transformation CLL to DLBCL.

Keywords: Cyclophosphamide, Fludarabine, Lymphoma, Richter Syndrome

Received December 11, 2014; Revised January 05, 2015; Accepted February 10, 2015

Citation: Mehrdad Payandeh, Masoud Sadeghi, Edris Sadeghi, Seyed Hamid Madani, Type of Treatment Can Effect on Transformation of Chronic Lymphocytic Leukaemia to Diffuse Large B-cell Lymphoma: A Rare Case with Review of Literature. American Journal of Cancer Prevention, 3 (1). 1-3. January 2015. doi:10.12691/ajcp-3-1-1

1. Introduction

Richter’s syndrome (RS) involves the development of an aggressive lymphoma and is a complication and disease transformation of chronic lymphocytic leukaemia (CLL) where clinical features, laboratory findings and treatment clearly differ from that of CLL [1,2] diffuse large B-cell lymphoma (DLBCL) is the most common type of RS [2]. Transformation of CLL into a large cell lymphoma has an incidence of 3-10% [3].

The RS was first described by Maurice N. Richter in 1928 as a syndrome of weight loss, abdominal discomfort, diffuse lymphadenopathy, massive organomegaly and lymphocytosis [4].

Central nervous system lymphomatous involvement in the setting of chronic lymphocytic leukemia (CLL), known as Richter transformation, is rare that in described cases involve isolated leptomeningeal or parenchimal involvement [5,6].

Herein, we report a case of a male patient with CLL who later referred to Our Clinic again with signs of DLBCL.

2. Case Report

In Apr 2014, a 51 year-old man referred to Hematology Clinic with complaint of three months of weight loss and sweating with generalized abdominal lymphadenopathy and the Bulky cervical lymph node. In future evaluation, he suffered of chronic lymphocytic leukemia (B-Cell type) (CD5, CD20 and CD23 were positive) that the pathology’s specimens, shown in Figure 1A to Figure 1C, demonstrated CLL in the patient (Rai system stage 4) and during seven years ago, he was treated with fludarabine and cyclophosphamide regiment for 6 courses. In Jun 2014, cervical biopsy pathology reported a new diagnosis of diffuse large B-Cell lymphoma (Figure 1D) without lesion and it was documented with immunohistochemistry (IHC) analysis that CD3, CD20, CD45 were positive and Bcl-2 was negative. He was treated with new regiment of R-CHOP for 6 courses. At Aug 2014, final diagnosis of diffuse large cell lymphoma of lymph node was established (Richter syndrome) and the patient became candidate for bone morrow transplantation.

One month after last course of chemotherapy, the patient referred again to our Clinic with complaint of headache and high-grade fever. Cerebrospinal fluid cytology was positive with lymphomatous involvement, and also brain CT SCAN showed parenchymal involvement. Gradually the level of his conscious decreased, therapy with high dose Methotrexate beginning and in follow with intrathecal chemotherapy. He referred for transplantation consult.

Figure 1. Pathology slide demonstrating chronic lymphocytic leukemia of A: lymph Node, B: Aspiration, C: Blood Smear and D: Pathology slide demonstrating diffuse large B-Cell lymphoma of cervical lymph node

3. Discussion

Richter transformation is defined as a diffuse large cell lymphoma, occurring by transformation of chronic lymphocytic leukemia (CLL) [5] and also Transformation of CLL into a large cell lymphoma has an incidence of 3-5% [3].

The Table 1 shows case reports for patients with CLL that developed diffuse large B-Cell lymphoma between Jun 2000 and Sep 2014. The patients were almost male and Age at diagnosis of CLL was more than 50 years, except four cases. Patient complaints at the first visit were different of each other but leukocytosis, lymphadenopathy and fever were more complaints. Kind of treatment for CLL was more with fludarabine, chlorambucil, cyclophosphamid.

Table 1. Case reports for patients with chronic lymphocytic leukemia that developed diffuse large B-Cell lymphoma (Jun 2000- Sep 2014)

The impact of initial fludarabine therapy on transformation to Richter syndrome (RS) in patients with chronic lymphocytic leukemia (CLL) is uncertain [13]. A study [3] suggested that high incidence of transformation can related to fludarabin therapy and also in our case and in a number of other cases [4,5,9,10,12], fludarabin therapy was used for treatment of CLL in the patients and it probably fludarabin can effect on transformation CLL to DLBCL. The Table 1 shows that combination of fludarabin with other drugs such as cyclophosphamide and endoxan in treatment of patients with CLL even in lower ages of 50 years can effect on transformation CLL to DLBCL. Solh M et al. [13] studied the outcomes of 521 patients with CLL who were randomized to initial fludarabine (F), chlorambucil (C) or F + C therapy that RS developed in 7%, 5% and 11% of patients, respectively. However, in future, it should consider to therapeutic options in patients of CLL. Although there is no published data on the prevalence of CNS involvement by RS, 5 (4%) had clinically identified CNS involvement. This low frequency of CNS involvement, performing of CNS staging (eg, lumbar puncture, magnetic resonance imaging of the head) only in patients with testicular, paranasal sinus, or epidural space involvement by DLBCL as well as those with 2 extranodal sites of disease, analogous to the approach in patients with de novo DLBCL.

The RS is a transformation to high-grade non-Hodgkin lymphoma in patients with CLL [7]. In our study, the patients was stage 4 in Rai system for CLL but other studies [8,12] showed that cases had stage 0 and 2, respectively. Therefore, Specialists should be careful that RS can create at each stage, and degree of CLL.

Isolated RS in the central nervous system (CNS) is very rare, a number of them with isolated leptomeningeal involvment, and rest of them with parenchymal involvement [6]. In our study, the patient had DLBCL in cervical lymph node that later cerebrospinal fluid cytology showed lymphomatous involvement, and also brain CT SCAN showed parenchymal involvement. This report shows an involvement of RS in two point of body and it is a very rare case.

4. Conclusions

Initial treatment type for CLL is important and specialists should be careful that probably fludarabin therapy alone or combination it with other drug especially cyclophosphamide can effect on transformation CLL to DLBCL even in lower ages of 50 years and at each stage, and degree of CLL. We think that one important point for this case is CSF analysis, that must be considered in protocol of therapy that be missed in this case. This mismanagement can be cause of CNS involvement very soon as our expectation.

References

[1]   | Olaniyi JA, Ibijola AA.Richter’s Syndrome: A Case Report. Med PrincPract. 2009.18(2):152-4.
[2]   | Ishida F, Nakazawa H, Takezawa Y, Matsuda K, Asano N, Sano K, et al. Richter transformation in the brain from chronic lymphocytic leukemia.J ClinExpHematop. 2013.53(2):157-60.
[3]   | Thornton PD, Bellas C, Santon A, Shah G, Pocock C, Wotherspoon AC, et al. Richter's transformation of chronic lymphocytic leukemia. The possible role of fludarabine and the Epstein-Barr virus in its pathogenesis. Leuk Res. 2005 Apr.29(4):389-95.
[4]   | Español I, Büchler T, Ferrá C, Gallardo D, Reyes P, Sarrá J, et al. Richter's syndrome after allogeneic stem cell transplantation for chronic lymphocytic leukaemia successfully treated by withdrawal of immunosuppression, and donor lymphocyte infusion. Bone Marrow Transplant. 2003 Feb.31(3):215-8.
[5]   | Ghofrani M, Tantiwongkosi B, Smith AS, Wasdahl DA. Richter transformation of chronic lymphocytic leukemia presenting as a dural-based non-hodgkinlymphomamass.AJNR Am J Neuroradiol. 2007 Feb.28(2):318-20.
[6]   | Resende LS, Bacchi CE, Resende LA, Gabarra RC, Niéro-Melo L. ISOLATED RICHTER’S SYNDROME IN CENTRAL NERVOUS SYSTEM. ArqNeuropsiquiatr. 2005 Jun.63(2B):530-1.
[7]   | Robak E, Góra-Tybor J, Kordek R, Wawrzyniak E, Bartkowiak J, Bednarek A, et al. Richter syndrome first manifesting as cutaneous B-cell lymphoma clonally distinct from primary B-cell chronic lymphocytic leukaemia.Br J Dermatol. 2005 Oct.153(4):833-7.
[8]   | Yager NM, Ghate K, Swan RL, Farrokh A, Barba K, Beegle SH.A rare case of empyema. Answer: Transformation of CLL into diffuse large B-cell lymphoma, also known as Richter syndrome.Chest. 2013 Jul.144(1):350-3.

[9]  
Salihoglu A, Ozbalak M, Keskin D, Tecimer T, Soysal T, Ferhanoglu B. An unusual presentation of a chronic lymphocytic leukemia patient with 17p deletion after reduced-intensity transplantation: Richter syndrome and concomitant graft-versus-host disease--case report.Transplant Proc. 2013 Sep.45(7):2845-8.

[10]   | Yu L, Bandhlish A, Fullen DR, Su LD, Ma L. Cutaneous Richter syndrome: report of 3 cases from one institution.J Am AcadDermatol. 2012 Nov.67(5):e187-93.
[11]   | Rasool J, Jeelani S, Jeelani S, Khan A, Lone MS. Chest Wall Swelling, A Rare Presentation of Richter's Transformation. Indian J Hematol Blood Transfus. 2010 Jun.26(2):70-2.
[12]   | Kaźmierczak M, Kroll-Balcerzak R, Balcerzak A, Czechowska E, Gil L, Sawiński K, et al. Hodgkin lymphoma transformation of chronic lymphocytic leukemia: cases report and discussion. Med Oncol. 2014 Jan.31(1):800.

[13]  
Solh M, Rai KR, Peterson BL, Kolitz JE, Appelbaum FR, Tallman MS, et al. The impact of initial fludarabine therapy on transformation to Richter syndrome or prolymphocytic leukemia in patients with chronic lymphocytic leukemia: analysis of an intergroup trial (CALGB 9011). Leuk Lymphoma. 2013 Feb.54(2):252-4.