One of our patients was seropositive for HIV and the other had T-cell prolymphocyte
leukemia, which suggests that lymphopenia could be a key risk factor.
Vural, "Rituximab-induced acute thrombocytopenia in a patient with prolymphocyte
leukemia," American Journal of Hematology, vol.
After a course of treatment, the patient showed refractory pleural effusion, in which prolymphocyte
count remained less than 5% and there was no evidence of large cell transformation.
leukemia (B-PLL) is a somewhat ill-defined, uncommon entity characterized by marked peripheral lymphocytosis composed of more than 55% prolymphocytes
(large lymphocytes with a prominent central nucleolus).
An occasional slightly larger lymphocyte with a single nucleolus (a prolymphocyte
) was present.
B-cell prolymphocytic transformation is diagnosed in progressive organomegaly and lymphocytosis with increase of prolymphocytes
>55% and is treated as aggressive CLL.
Bone marrow aspirate smear revealed lymphocyte dominance at the rate of 60% without increased prolymphocytes
. The karyotype analysis revealed 46XY karyotype, and chromosome analysis revealed no chromosomal anomaly.
A May-Griinwald-Giemsa-stained peripheral blood film revealed typical small mature lymphocytes with condensed chromatin, with less than 10% of prolymphocytes
. A typical CLL phenotype was found with 80% of B cells CD19+ with coexpression of CD5, CD23, CD200, and lambda light chain restriction and weak expression of CD20, CD22, and CD79b.
T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive post-thymic malignancy that is characterized by the proliferation of small- to medium-sized prolymphocytes
. (1) It has distinctive clinical, morphological, immunophenotypic, and cytogenetic features and accounts for less than 2% of all forms of small lymphocytic leukemias in adults over the age of 30.
Nuclear staining with LEF1 is positive in lymphoma cells of SLL; the nuclear staining is stronger in prolymphocytes
and in the transformed large lymphoma cells of Richter syndrome (not shown) (original magnification X500).
In the late 1990s, various groups reported a correlation between clinical outcome and Rai stage with respect to the morphology of CLL lymphocytes, the pattern ofbone marrowinfiltration, lymphocyte doubling time, and the percentage of prolymphocytes