Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Durable remission of large B-cell lymphoma transformed from lymphoplasmacytic lymphoma/Waldenström macroglobulinemia successfully treated with sequential immunochemotherapy followed by reduced-intensity allogeneic stem cell transplantation

Bone Marrow Transplantation volume 41, pages 591–593 (2008)Cite this article

Although most patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) have an indolent clinical course with a median survival of 60 months,1 5–13% of them experience transformation into diffuse large B-cell lymphoma (DLBCL).2, 3, 4 The prognosis after large-cell transformation is very poor, with a reported median survival of 2–5 months,3, 4 and no effective therapeutic approach has been established. Here, we report a case of transformed DLBCL from LPL/WM successfully treated with sequential rituximab-based immunochemotherapy immediately followed by reduced-intensity conditioned allogeneic stem cell transplantation (RICT).

When she was 54-year-old, she became refractory to those therapies, and was treated with two cycles of cladribine and mitoxantrone with a partial response. However, 2 months after completion of the chemotherapy, her lactate dehydrogenase (LDH) levels rose rapidly from 138 to 1461 IU/l, although her IgM levels remained stable (10 g/l). Although computed tomography scans did not show any abnormalities, BM examination demonstrated a hypercellular marrow with diffuse blastic cell infiltration. FCM studies of BM revealed two distinct tumor populations: the dominating larger cells expressed CD5−, CD10+, CD19+, CD20+, HLA-DR+, sm-IgM−, sm-IgD−, sm-IgG+, sm-kappa+ (CD10+/sm-IgM− cells, 48.3% of ANC) and minor smaller cells expressed CD5−, CD10−, CD19+, CD20+, HLA-DR−, sm-IgM+, sm-IgD+, sm-IgG−, sm-kappa+ (CD10−/sm-IgM+ cells, 2.2% of ANC), which was identical to the immunophenotype of the pre-existing lymphoplasmacytic cells. G-banded cytogenetic analysis showed a normal karyotype. She was diagnosed with transformed DLBCL from LPL/WM and treated with three courses of EPOCH chemotherapy combined with rituximab (R-EPOCH),5 resulting in a reduction of LDH (141 IU/l) and IgM (4.68 g/l). Computed tomography scans showed no abnormalities. However, serum immunoelectrophoresis showed residual IgM paraprotein and FCM studies demonstrated the residual CD10−/IgM+ tumor cells in BM (0.3% of ANC), indicating that she had achieved a complete response of the DLBCL and a partial response of the LPL/WM.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Dimopoulos MA, Panayiotidis P, Moulopoulos LA, Sfikakis P, Dalakas M . Waldenstrom's macroglobulinemia: clinical features, complications, and management. J Clin Oncol 2000; 18: 214–226.

    Article  CAS  Google Scholar 

  2. Garcia R, Hernandez JM, Caballero MD, Gonzalez M, San Miguel JF . Immunoblastic lymphoma and associated non-lymphoid malignancies following two cases of Waldenstrom's macroglobulinemia. A review of the literature. Eur J Haematol 1993; 50: 299–301.

    Article  CAS  Google Scholar 

  3. Kyrtsonis MC, Vassilakopoulos TP, Angelopoulou MK, Siakantaris P, Kontopidou FN, Dimopoulou MN et al. Waldenstrom's macroglobulinemia: clinical course and prognostic factors in 60 patients. Experience from a single hematology unit. Ann Hematol 2001; 80: 722–727.

    Article  CAS  Google Scholar 

  4. Lin P, Mansoor A, Bueso-Ramos C, Hao S, Lai R, Medeiros LJ . Diffuse large B-cell lymphoma occurring in patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia. Clinicopathologic features of 12 cases. Am J Clin Pathol 2003; 120: 246–253.

    Article  Google Scholar 

  5. Jermann M, Jost LM, Taverna C, Jacky E, Honegger HP, Betticher DC et al. Rituximab-EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Ann Oncol 2004; 15: 511–516.

    Article  CAS  Google Scholar 

  6. Tsimberidou AM, O'Brien S, Khouri I, Giles FJ, Kantarjian HM, Champlin R et al. Clinical outcomes and prognostic factors in patients with Richter's syndrome treated with chemotherapy or chemoimmunotherapy with or without stem-cell transplantation. J Clin Oncol 2006; 24: 2343–2351.

    Article  CAS  Google Scholar 

  7. Coiffier B, Haioun C, Ketterer N, Engert A, Tilly H, Ma D et al. Rituximab (anti-CD20 monoclonal antibody) for the treatment of patients with relapsing or refractory aggressive lymphoma: a multicenter phase II study. Blood 1998; 92: 1927–1932.

    CAS  PubMed  Google Scholar 

  8. Wilson WH, Bryant G, Bates S, Fojo A, Wittes RE, Steinberg SM et al. EPOCH chemotherapy: toxicity and efficacy in relapsed and refractory non-Hodgkin's lymphoma. J Clin Oncol 1993; 11: 1573–1582.

    Article  CAS  Google Scholar 

  9. Tomonari A, Iseki T, Ooi J, Takahashi S, Ishii K, Takahashi T et al. Using related donors other than genotypically HLA-matched siblings in allogeneic hematopoietic stem cell transplantation for hematologic disease: a single institution experience in Japan. Int J Hematol 2002; 76: 354–359.

    Article  Google Scholar 

  10. Szydlo R, Goldman JM, Klein JP, Gale RP, Ash RC, Bach FH et al. Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings. J Clin Oncol 1997; 15: 1767–1777.

    Article  CAS  Google Scholar 

Download references

Author information

Author notes

  1. K Imada

    Present address: 3Current Address: Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan.,

Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    R Yamamoto, A Takaori-Kondo, J Kanda, K Imada, T Ichinohe, T Ishikawa & T Uchiyama

  2. Department of Clinical Pathology, Kyoto University Hospital, Shogoin-Kawaracho, Sakyo-ku, Kyoto, JapanE-mail: atakaori@kuhp.kyoto-u.ac.jp,

    K Ohmori

Authors
  1. R Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A Takaori-Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K Imada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T Ichinohe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K Ohmori
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamamoto, R., Takaori-Kondo, A., Kanda, J. et al. Durable remission of large B-cell lymphoma transformed from lymphoplasmacytic lymphoma/Waldenström macroglobulinemia successfully treated with sequential immunochemotherapy followed by reduced-intensity allogeneic stem cell transplantation. Bone Marrow Transplant 41, 591–593 (2008). https://doi.org/10.1038/sj.bmt.1705944

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705944

This article is cited by

Search

Advanced search

Quick links