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 was found.
His
prolymphocyte count remained less than 5% and there was no evidence of large cell transformation.
B-cell
prolymphocyte 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.