1例伴12三体染色体核型异常的慢性淋巴细胞白血病转化为Richter综合症

本研究探讨慢性淋巴细胞白血病(CLL)患者的临床特征、染色体核型与Richter综合症(RS)发生的关系。利用血清学检测、流式细胞术和间期荧光原位杂交技术等方法,随访观察1例RS患者发病时的临床特征、染色体核型、治疗方式及其反应和病情演化。结果表明,患者发病时呈现典型的CLL表现,即表达CD5、CD19、CD23,但FMC7、CD38和ZAP70表达阴性;Binet分期C期,伴12三体染色体核型异常,对标准方案FCR治疗反应差等特点。病程第5个月时患者出现非炎症性发热,淋巴结迅速增大和血清乳酸脱氢酶升高,经淋巴结病理活检证实向RS转化。结论:12三体是RS转化的高危因素之一,RS的发生还可能与CLL治疗方法有关。

A case of Richter syndrome transformed from chronic lymphocytic leukemia with karyotype aberration of trisomy 12

This study was aimed to investigate the relationship between Richter's syndrome (RS) transformation and clinical characteristics as well as karyotype of patient with chronic lymphocytic leukemia (CLL). By the follow-up of a patient with CLL, the clinical characteristics, karyotype, treatment pattern and its effect, as well as disease progression were monitored regularly with serological test, flow cytometry and FISH technique. The results indicated that the patient typically presented with history of CLL at initial diagnosis, with expression of CD5(+), CD19(+) and CD23(+), Binet stage C, as well as karyotype aberration of trisomy 12, and poorly responded to 4 cycles of standard chemotherapy of FCR regimen. The disease progression was confirmed at 5 months with the symptoms of fever in the absence of infection, elevated lactate dehydrogenase level and rapidly enlarging lymphnodes which showed typically diffuse large B cell lymphoma by the biopsy. It is concluded that karyotype aberration of trisomy 12 is one of the risk factors for RS transformation, and treatment pattern of the patient with CLL may be associated with the transformation of RS.