Alemtuzumab
- PDF / 184,575 Bytes
- 1 Pages / 623.591 x 841.847 pts Page_size
- 84 Downloads / 151 Views
1
★S
First report of Richter’s syndrome in an elderly patient: case report Epstein-Barr virus negative Richter’s syndrome occurred in a 70-year-old* woman following treatment with alemtuzumab for B cell chronic lymphocytic leukaemia (CLL) . The woman, who had received corticosteroids, started alemtuzumab [dosage not stated]. Four weeks later, she developed severe neutropenia and treatment was withheld. Twelve weeks after alemtuzumab initiation, she developed a fever, and had a rapidly increasing lactate dehydrogenase level (2000 U/L), and recurrent anaemia and thrombocytopenia. Her WBC count increased to 3000/µL. One quarter of the cells was still recognised as small lymphocytes and another quarter was designated as morphologically abnormal. These lymphocytes were large-sized, with vesicular nuclei, sometimes with visible nucleoli, and with an abundant basophilic cytoplasm that was frequently vacuolated. Bone marrow biopsy showed a diffuse infiltration by large blasts replacing most of her normal haemopoietic and fat cells. Flow cytometric analysis of the lymphoma cells revealed a typical CLL profile despite the large cell characteristics of transforming B cells; the abnormal cells expressed a different light chain. Immunoglobulin heavy chain analysis confirmed that Richter’s syndrome and CLL had a different clonal origin. Clonality analysis showed that Richter’s syndrome had evolved from a clone that appeared 2 years before appearance of the syndrome. [Treatment and patient outcome not stated.] Author comment: "It seemed that the initial CLL clone was effectively suppressed by the monoclonal therapy while the evolving clone could suddenly multiply unchecked. . . it is reasonable to suppose that purine analogues and alemtuzumab contribute to the development of [Richter’s syndrome] in some CLL patients through profound and prolonged T-cell depletion." * It was confirmed by personal communication with the author that the patient was 70 years old when she developed Richter’s syndrome. Janssens A, et al. EBV negative Richter’s syndrome from a coexistent clone after salvage treatment with alemtuzumab in a CLL patient. American Journal of 801049353 Hematology 81: 706-712, No. 9, Sep 2006 - Belgium
» Editorial comment: A search of AdisBase and Medline did not reveal any previous case reports of Richter’s syndrome or non-Hodgkin’s lymphoma in association with alemtuzumab. The WHO Adverse Reactions database contained four reports of non-Hodgkin’s lymphoma associated with alemtuzumab.
0114-9954/10/1127-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 11 Nov 2006 No. 1127
Data Loading...
