弥漫性大B细胞淋巴瘤转化为前体B细胞急性淋巴细胞白血病：临床病理特征及克隆关系

Transformation of diffuse large B-cell lymphoma into pre-B acute lymphoblastic leukemia: clinicopathologic features and clonal relationship.

作者信息

Au W Y, Srivastava G, Wong K Y, Chung L P, Ma S K, Wan T S, Kwong Y L

机构信息

Department of Medicine, Queen Mary Hospital, Hong Kong, China.

出版信息

Hum Pathol. 2004 Jul;35(7):900-3. doi: 10.1016/j.humpath.2004.04.002.

DOI:10.1016/j.humpath.2004.04.002

PMID:15257558

Abstract

A patient with fibrosing alveolitis developed a diffuse large B-cell (DLBC) lymphoma that expressed CD20 and CD30. After an initial response, the lymphoma relapsed and was salvaged with further chemotherapy. After another remission of 3 years, a pre-B-cell acute lymphoblastic leukemia (ALL), which expressed CD10, CD19, CD22, CD79a, CD34 and terminal deoxyribonucleotidyl transferase, developed and led to death. Molecular analysis of the immunoglobulin heavy-chain gene showed that the initial lymphoma and its relapse were clonally related. At leukemic relapse, 2 clones related to the initial and relapsed lymphoma clones were present. DLBC lymphomas arise from post-follicle center B cells, whereas ALL arises from pregerminal B cells. Therefore, a direct transformation of DLBC lymphoma to ALL appears unlikely. The overall features suggest instead separate lymphoma and leukemic evolution from a common mutated B-cell precursor rather than transformation of DLBC lymphoma to ALL.

摘要

一名患有纤维化肺泡炎的患者发生了弥漫性大B细胞（DLBC）淋巴瘤，该淋巴瘤表达CD20和CD30。初始缓解后，淋巴瘤复发并通过进一步化疗挽救。在又一次缓解3年后，发生了一种表达CD10、CD19、CD22、CD79a、CD34和末端脱氧核苷酸转移酶的前B细胞急性淋巴细胞白血病（ALL），并导致死亡。免疫球蛋白重链基因的分子分析表明，初始淋巴瘤及其复发在克隆上相关。在白血病复发时，存在2个与初始和复发淋巴瘤克隆相关的克隆。DLBC淋巴瘤起源于滤泡后中心B细胞，而ALL起源于生发前B细胞。因此，DLBC淋巴瘤直接转化为ALL似乎不太可能。总体特征反而提示从一个共同的突变B细胞前体分别发生淋巴瘤和白血病演变，而不是DLBC淋巴瘤转化为ALL。