Richter’s syndrome represents the progression of chronic lymphocytic leukemia (CLL) to more aggressive diseases, most frequently diffuse large B-cell lymphoma, while Hodgkin’s lymphoma (HL) and hairy cell leukemia (HCL) are rarely described. The first case involved a 67-year-old man with a diagnosis of a high-risk stage-II CLL treated with rituximab and ibrutinib, developed a HL nodular sclerosis variant after three months of therapy for CLL. After achieving a complete remission for HL and ibrutinib cessation because of drug-related cardiotoxicity, the patient relapsed after five months off-therapy and died due to disease progression after two cycles of brentuximab-vedotin. The second case involved an 83-year-old female with a diagnosis of stage-IV CLL treated with rituximab plus bendamustine who developed a HCL eight years later. Pentostatin was unsuccessfully employed as upfront HCL therapy, and the patient was then switched to rituximab while in remission for CLL. In conclusion, Richter’s transformation risk rate might be higher in patients treated with novel targeted therapies, and multiparametric flow cytometry and lymph node biopsy at relapse could help in early identifying small clones. The treatment of predominant neoplasia is mandatory, and disease-specific drugs are administered; however, clinical efficacy might be lower in these patients.
Leone et al. have recently documented a trend-increase of bone marrow (BM) CD3 + CD56 + T regulatory cells in myelodysplastic syndromes (MDS), with concomitant reduction of cytotoxic T cell activity favoring escape of leukemic blasts to immunological surveillance.
Hairy cell leukemia (HCL), a rare indolent B-cell lymphoproliferative disorder, is characterized by the presence of bone marrow (BM) and peripheral blood hairy cells with cytoplasmic projections, splenomegaly, pancytopenia, and recurrent infections. In most cases, HCL cells harbor a V600E somatic mutation on B-raf proto-oncogene (BRAF), causing constitutive activation of downstream signaling pathways, especially mitogen-activated protein kinase (MEK) 1 and 2. Cytogenet-
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