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TCT 2021: Case of Accelerated-Phase CLL/SLL Relapsing as PTCL After Transplantation

By: Vanessa A. Carter, BS
Posted: Friday, February 19, 2021

Brenen Swofford, DO, of the University of Kentucky–Markey Cancer Center, Lexington, and colleagues followed the case of a 57-year-old man diagnosed with unmutated IGHV chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). At the 2021 Transplantation & Cellular Therapy Meetings (TCT), they presented this rare case of accelerated CLL/SLL relapsing as peripheral T-cell lymphoma (PTCL) after allogeneic transplantation (Abstract 174).

Diagnosed in 2010 with unmutated IGHV CLL/SLL, the patient later acquired del17p. While on ibrutinib treatment in 2019, he presented with progressing adenopathy. A biopsy revealed accelerated-phase CLL/SLL with a confluent proliferative center and Ki67 levels at 30% to 40%. A PET scan demonstrated Lugano 4/5 disease after chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), plus rituximab. The patient was transitioned to obinutuzumab and venetoclax and achieved a complete response based on a repeat PET scan.

A matched unrelated donor hematopoietic stem cell transplant conditioned with bendamustine, fludarabine, and rituximab was performed in February 2020. A bone marrow biopsy on day 100 of treatment demonstrated persistent chronic CLL/SLL, and a PET scan showed extensive hypermetabolic lymphadenopathy. The biopsy confirmed PTCL not otherwise specified, with concurrent CD5-positive monoclonal B-cell population.

The patient received high-dose methotrexate and cytarabine with intrathecal therapy followed by CHOP and high-dose methotrexate on day 15 of treatment, leading to a complete metabolic response. The patient remains in complete response after 8 months of treatment.

Among 54,890 patients who developed CLL/SLL, 50 developed T-cell lymphoma. Patients with CLL/SLL tend to have an increased risk of T-cell lymphoma. Affecting 36% of patients, the most common diagnosis was PTCL not otherwise specified; 18% had primary cutaneous T-cell lymphoma.

Disclosure: For full disclosures of study authors, visit tct.confex.com.



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