Henry Ford Hospital Medical Journal


We report three patients with chronic lymphocytic leukemia (CLL) who developed malignant lymphomas of unusual character and modes of presentation. Two of the patients had received low doses of chlorambucil for several years before they developed malignant lymphoma, diffuse, large cell type (LCL). In one of these patients LCL manifested as a grossly evident osteolytic lesion. In the second patient LCL developed initially as a localized lesion in the iliac bone. Both patients died within a few weeks after LCL was diagnosed. The third patient, who was found to have CLL during a routine examination, did not receive any therapy for the leukemia. Within six months the patient developed diffuse malignant lymphoma, mixed small and large cell type, with total extinction of the leukemic component. The disease responded favorably to chemotherapy for lymphoma, and the patient is alive with minimal residual disease at this time. Immunohistochemical studies in all three patients suggested transformation or dedifferentiation of the original neoplastic lymphoid clone rather than de novo appearance of another neoplasm.