CD 5+ Peripheral B Cell Lymphoma With Transformation to CD 5+ Diffuse Large B Cell Lymphoma in the CNS: A Case Report Treated With Rituximab, High Dose Methotrexate, Cytarabine, and Intrathecal Methotrexate

Abstract

B-cell non-Hodgkin’s lymphoma includes several subtypes, notably Diffuse Large B-Cell Lymphoma (DLBCL), the most common B-cell subtype. Each presentation has its defining characteristic, of which CD5 positivity is notoriously known for being a poor prognostic factor. CD5 positivity has a high female preponderance, more commonly involves the bone marrow, presents with higher LDH levels and B symptoms on presentation, and stage 3-4 on the diagnosis. The exact incidence of CD5+ DLBCL arising from Chronic Lymphocytic Leukemia (CLL) is not explicitly defined in the literature, but it can be expected in about 5-10% of cases on average. Our patient is a 52-year-old female with no previous history of malignancy who presented with bilateral lower extremity weakness progressing to paraplegia and was found to have a CD5+ B-cell lymphoma in the peripheral blood with a CD5+ Diffuse Large B-cell lymphoma in the central nervous system (CNS). Treatment consisted of Rituximab, High dose Methotrexate (HD-MTX), and Cytarabine/intrathecal Methotrexate for CNS involvement for four cycles. Our patient tolerated therapy with improved neurological symptoms and no evidence of blasts on her peripheral smear or malignant cells on Cerebral Spinal Fluid Flow Cytometry after treatment. Her presentation and response to treatment highlight a possible treatment scheme for this rare and aggressive disease subtype.

Diffuse large B cell lymphoma CD5-positive arising in an immune deficiency and immune dysregulation setting: A case report and brief review of the literature

“…[23,24] In addition, each presentation has its defining characteristic, of which CD5 positivity is notoriously known for being a poor prognostic factor. [21] Our patient was considered to have a good outcome, being considered disease free after periodic clinical and paraclinical testing, and being referred to the surgery clinic for removal of the iliac anus and restoration of digestive continuity.…”

“…According to Jain et al [20] , CD5 positivity is classically associated with a poor prognostic factor, having female preponderance, more bone marrow involvement, higher LDH levels, B symptoms on presentation, and Ann Arbor stage 3 to 4 on diagnosis. [21] In this current case, based on the morphology and immunophenotype, we present a case of a young male patient with a diagnosis of AIDS-related diffuse large B cell lymphoma, CD5-positive, with a high LDH level and stage IV Ann Arbor at presentation. Using the Hans algorithm, we concluded that the cell of origin was a non-GCB.…”