Plasmacytoid Transformation of Chronic Lymphocytic Leukemia CLL with Multiple Lytic Bony Lesions

Abstract 4590

Richter transformattion in patients with Chronic Lymphocytic Leukemia CLL can happen in 3%- 15%. This involve transformation of relatively indolent CLL cells into higher grade and aggressive form of Lymphoma. Plasmcytoid transformation of CLL with paraprotinemia, multiple lytic lesions and hypercalcemia can occur. This abstract will describe six patients with CLL who presented with hypercalcemia and lytic bony lesions in the course of their disease. Mean age is 72 years old. All were males, four whites and two blacks. One patient had solitary bony lesion with solitary small lung lesion that biopsy showed moderately differentiated adenocarcinoma. Bone scan was negative and monoclonal IgG lambda was present. The second patient had multiple lytic lesions with nephrotic range proteinuria of five grams; kappa light chain with bone marrow biopsy showing plasma more than 10%. Two patients has progressive adenopathy with elevated IgM level more than 2 grams with increased LDH. One patient progressed to PLL and developed renal failure that required hemodialysis with lambda light chain in urine. One patient with progressive bony lesion involving the scapula and close vertebrae with IgG spike. All patients expired in a short period less than six months with therapy. Biopsy was available for four patients which showed plasmacytoid or plasmablastic morphology.

In conclusion: Plasmacytoid transformation in patient with CLL should be considered when hypercalcemia, lytic bony lesions and paraproteinemia is present.