DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20200266

Diffuse large B-cell lymphoma in a patient with chronic myelogenous leukemia on accelerated phase with bilateral pleural effusion: a case report

M. Huki Zukhrufan, Eifel Faheri

Abstract


Chronic Myelogenous Leukemia (CML) is a myeloproliferative disorder of pluripotent stem cells. The pathogenesis of CML is known to be related to mutations in the form of Philadelphia chromosomes. The incidence of CML constitutes 20% of all cases of leukemia in adults. The current gold standard for CML therapy is using tyrosine kinase inhibitors (TKI), Imatinib. Non-Hodgkin Lymphoma (NHL) is a malignancy that develops from lymph nodes. In NHL the formation of malignant cells is in the form of lymphocytes that are at one of the differentiation levels of either T lymphocytes or B lymphocytes. Diffuse large B cell lymphoma is the most common NHL, representing about 40% of all lymphoma cases. NHL management is targeted chemotherapy using rituximab combined with cyclophosphamide, doxorubicine, vincristine and prednisone. A Thirty-four year-old female patient has been reported with the main complaint of fatigue and pale weakness accompanied by an enlarged abdomen. Complaints are also accompanied by a lump in the right neck, fever, productive cough and shortness of breath. The patient has been known to suffer from CML with BCR-ABL (+) since five years ago and received Imatinib therapy, but then the patient stopped treatment himself. On physical examination found anemic, multiple enlargement of the neck lymph nodes, wet crackles soft and loud in the basal of both lungs and splenomegaly. On investigations found severe anemia, thrombocytopenia and blast 13%, increased d-dimer, bronchopneumonia-compliant infiltrate and bilateral pleural effusion on chest x-ray, results of exudate pleural fluid analysis with the cytology of a malignant smear metastasis of lymphoma to the pleura, histopathology of the neck lymph nodes with chest x-ray, analysis of exudate pleural fluid with the cytology of a malignant smear metastasis of lymphoma into the pleura, histopathology of the neck lymph nodes with the results of diffuse large B-Cell lymphoma, as well as enlargement of paraaortic lymph nodes, hepatosplenomegaly and chronic pancreatitis on abdominal ultrasound. Patients was given antibiotics, transfusion of packed red cells and platelets, pleural tap and chemotherapy. The patient was planned to undergo chemotherapy for 6 cycles of 21 days, and a CD20 examination was performed. The incidence of NHL in patients with good CML in imatinib therapy is not yet certain whether there is a direct relationship.


Keywords


Chronic myelogenous, Imatinib, Non-hodgkin's lymphoma

Full Text:

PDF

References


Goldman JM. Chronic myeloid leukemia: a historical perspective. Semin Hematol J. 2010;47(4):302-11.

Huang X, Cortes J, Kantarjian H. Estimation of the increasing prevalence and plateau prevalence of chronic myeloid leukemia in the era of tyrosine kinase inhibitors therapy. Cancer PMC J. 2012;118(12):3123-7.

Silaber C, Mayerhofer M, Aqis H, Sagaster V, Mannhalter C, Sperr WR, et al. Chronic myeloid leukemia: pathophysiology, diagnostic parameters and current treatment concepts. Wien Klin Wochenschr J. 2003;115(14):485-504.

Kantarjian HM, Talpaz M, Giles F, O’Brien S, Cortes J. New insight into the pathophysiology of chronic myeloid leukemia and imatinib resistance. Ann Intern Med J. 2006;145(12):913-23.

Thompson PA, Kantarjian H, Cortes JE. Diagnosist and treatment of chronic myeloid leukemia in 2015. Mayo Clin Proc J. 2015;90(10):1440-54.

Kumar S, Gupta VK, Bharti A, Meena LP, Gupta V, Shukla J. A study to determine the clinical, cytogenetic and molecular profile in CML patient in and around eastern UP, India. J Family Med Prim Care. 2019;8(7):2450-55.

Mottalib MA, Sultana TA, Khalil MI, Gan SH, Islam MS, Choudhury S, et al. Phase distribution of chronic myeloid leukemia in Bangladesh. BMC Res Notes. 2014;(7):142-7.

Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2018 update on diagnosis, therapy and monitoring. Am J Hematol. 2018;93(3):442-59.

Moura MS, Benevides TC, Delamain MT, Duarte GO, Percout PO, Dias MA, et al. Evaluation of anemia after long-term treatment with imatinib in chronic myeloid leukemia patients in chronic phase. Hematol Transfus Cell Ther. 2019;41(4):329-34.

Li S, Young KH, Medeiros LJ. Diffuse large B-cell lymphoma. Pathol J. 2018;50(1):74-87.

Miranda MB, Lauseker M, Kraus MP, Proetel U, Hanfstein B, Fabarius A, et al. Secondary malignancies in chronic myeloid leukemia patients after imatinib-based treatment: long-term observation in CML Study IV. Leukemia J. 2016;30(6):1255-62.

Starr AG, Jonna SR, Chahine JJ, Kallakury BV, Ujjani CS. Concurrent diagnosis of chronic myeloid leukemia and follicular lymphoma: an unreported presentation. Hindawi. 2018:1-4.

Sweeney TE, Khatri P. Hospital-acquired pneumonia: a host of factor. Am J Respir Crit Care Med. 2016;194 (11):1309-11.

Huoi C, Vanhems P, Nicolle MC, Michallet M, Benet T. Incidence of hospital-aquired pneumonia, bacteraemia and urinary tract infections in patients with haematological malignancies, 2004-2010: a surveillance-based study. PLOS One J. 2013;3:1-8.

Niederman MS. Antibiotic treatment of hospital-aquired pneumonia: is it different from ventilator-associated pneumonia? Curr Opin Crit Care. 2018;24(5):353-60.

Russell CD, Koch O, Laurenson IF, O'Shea DT, Sutherland R, Mackintosh CL. Diagnosis and features of hospital-acquired pneumonia: a retrospective cohort study. J Hospital Infect. 2016;92(3):273-9.

Chen YP, Huang HY, Lin KP, Medeiros LJ, Chen TY, Chang KC. Malignant effusions correlate with poorer prognosis in patients with diffuse large B-Cell lymphoma. Am J Clin Pathol. 2015;143(5):707-15.

Jiang Y, Xie W, Hu K, Sun J, Zhu X, Huang H. An aggressive form of non-Hodgkin’s lymphoma with pleural and abdominal chylous effusion: a case report and review of the literature. Oncel Lett J. 2013;6(4):1120-2.

Ejaz A, Ahmed MM, Tasleem A, Niazi MR, Ahsraf MF, Ahmad I, et al. Thromboprophylaxis in intensive care unit patients: a literature review. Cureus J. 2018;10(9):1-8.

Lew D, Afghani E, Pandol S. Chronic pancreatitis: current status dan challenges for prevention and treatment. Dig Dis Sci J. 2017;62(7):1702-12.