Double-Hit Lymphoma Presenting with Aggressive Progression: A Case Report

Öz

Double-Hit lymphoma is an aggressive B-cell malignancy with a high proliferative rate that may be fatal within months if not treated promptly. We presented a very aggressive and fatal case of a Double-Hit Lymphoma. 18 years old male patient referred Ear-Nose-Throat outpatient clinic due to swelling under the chin and an excisional biopsy was performed. High grade Burkitt like lymphoma CD20 (+) was reported. Approximately 12 months after diagnosis patient who was accepted as a stage IIIB according to Ann-Arbor staging system died of disease progression despite the various treatment protocols of high dose chemotherapy followed by autologous bone marrow transplantation. Double-Hit lymphoma is aggressive and can be fatal. Therefore, treatment should be initiated without delay after diagnosis. Key words: Double-Hit Lymphoma; Burkitt Like Lymphoma; Aggressive; Bone Marrow Transplantation.

Anahtar Kelimeler

• Double-Hit Lymphoma; Burkitt Like Lymphoma; Aggressive; Bone Marrow Transplantation.

Agresif Seyreden Double-Hit Lenfoma: Bir olgu sunumu

Öz

Double-Hit lenfoma acil tedavi edilmez ise aylar içinde ölümcül olabilen kötü seyirli B hücreli lenfomadır. Biz burada kötü seyirli giden fatal seyreden Double-Hit Lenfomalı erişkin bir olguyu sunduk. 18 yaşındaki erkek hasta Kulak Burun Boğaz polikliniğine çene altındaki şişlik nedeni ile başvurdu ve eksizyonel biopsi yapıldı. Hastanın biyopsisi CD20(+) Burkitt-like lenfoma olarak rapor edildi. Ann-Arbor evreleme sistemine göre evre IIIB kabul edilen hasta tedavi protokolündeki kemoterapotiklere ve yüksek doz kemoterapi eşliğinde otolog kemik iliği nakline cevap vermedi. Hastamız tanı konulmasından yaklaşık 12 ay sonra kaybedildi. Double-Hit lenfoma agresif gidişli olabilir ve fatal seyirli seyredebilir. Bu yüzden tanıdan sonra zaman kaybetmeden tedavi başlanmalıdır. Anahtar kelimeler: Double-Hit Lenfoma; Burkitt Like Lenfoma; Agresif; Kemik İliği Nakli.

Anahtar Kelimeler

• Double-Hit Lenfoma; Burkitt Like Lenfoma; Agresif; Kemik İliği Nakli.

Kaynakça

1. Kluin PM, Harris NL, Stein H, Leoncini L, Raphael M, Campo E, et al. B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. In: Swerdlow SH, Campo E, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008. p. 265-6.
2. Tomita N, Tokunaka M, Nakamura N, et al. Clinicopathological features of lymphoma/leukemia patients carrying both BCL2 and MYC translocations. Haematologica 2009;94:9359-43.
3. Snuderl M, Kolman OK, Chen YB, et al. B-cell lymphomas with concurrent IGH-BCL2 and MYC rearrangements are aggressive neoplasms with clinical and pathologic features distinct from Burkitt lymphoma and diffuse large B-cell lymphoma. Am J Surg Pathol 2010; 34:327-40.
4. Johnson NA, Savage KJ, Ludkovski O, et al. Lymphomas with concurrent BCL2 and MYC translocations: the critical factors associated with survival. Blood 2009;114:2273-9.
5. LaCasce AS, Kho ME, Friedberg JW, et al. Comparison of referring and final pathology for patients with non- Hodgkin’s lymphoma in the National Comprehensive Cancer Network. J Clin Oncol 2008;26:5107-12.
6. Evens AM, Gordon LI. Burkitt's and Burkitt-like lymphoma. Curr Treat Options Oncol 2002;3:291-305.
7. Thomas DA, O'Brien S, Faderl S, Manning JT Jr, Romaguera J, Fayad L, et al. Burkitt lymphoma and atypical Burkitt or Burkitt-like lymphoma: Should these be treated as different diseases? Curr Hematol Malig Rep 2011;6:58-66.
8. Parker SM, Olteanu H, Vantuinen P, Lawton CH, Schultz CJ, et al. Follicular transformation to dual translocated Burkitt like lymphoma: improved disease control associated with radiaton therapy. Int J Hematol 2009;90:616-22.

9. Hiroaki T, Shinichiro H, Daijiro A, Shio S. Double-Hit Lymphoma at second relapse of Burkitt-like Lymphoma; A case Report. J Clin Exp Hematopathol 2011; 51:43-7.
10. Sietse M Aukema, Reiner Siebert, Ed Schuuring, Gustaaf W van Imhoff, Hanneke C Kluin-Nelemans, Evert-Jan Boerma, Philip M Kluin. Double-hit B-cell lymphomas. Blood 117:2319-31.