Leukemic Diffuse Large B-Cell Lymphoma in a Patient With Myeloproliferative Disorder

Essential thrombocythemia is well-known to transform to other myeloid disorders, such as leukemia; however, the risk for development of lymphoma is not as well studied. This case report discusses a 76-year-old man with a history of prefibrotic post-essential thrombocythemia myelofibrosis on ruxolitinib, who developed anemia, thrombocytopenia, and leukocytosis with peripheral blasts. Results of a bone marrow biopsy and PET and CT scans revealed stage IV leukemic diffuse large B-cell lymphoma. Several days after cessation of ruxolitinib, the patient developed fevers, hypotension, and low-grade disseminated intravascular coagulation, and subsequently developed spontaneous tumor lysis syndrome, which resulted in death. This case is unique in several aspects: it highlights the rare possibility of lymphomatous transformation of myeloproliferative disorders, an unusual presentation of lymphoma masquerading as leukemia, and the possibility of ruxolitinib withdrawal syndrome. Additionally, this case serves as a reminder that the use of novel therapies should be adopted after a thorough assessment of long-term risks, including those associated with abrupt withdrawal.

Target Audience

This activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer.

Learning Objectives

Upon completion of this activity, participants will be able to:

  • Summarize the use of ruxolitinib and its potential side effects in patients with post-essential thrombocythemia myelofibrosis
  • Identify the various mechanisms related to the transformation of essential thrombocythemia into NHL
Additional information
Supporters: 

No commercial support was received for this article.

Course summary
Available credit: 
  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician
Course opens: 
03/06/2015
Course expires: 
03/06/2016
Cost:
$0.00
Vijaya Raj Bhatt, MBBS
Department of Internal Medicine, Division of Hematology-Oncology
University of Nebraska Medical Center
Omaha, Nebraska
R. Gregory Bociek, MD
Department of Internal Medicine, Division of Hematology-Oncology
University of Nebraska Medical Center
Omaha, Nebraska
Ji Yuan, PhD
Department of Pathology and Microbiology
University of Nebraska Medical Center
Omaha, Nebraska
Kai Fu, MD, PhD
Department of Pathology and Microbiology
University of Nebraska Medical Center
Omaha, Nebraska
Timothy C. Greiner, MD
Department of Pathology and Microbiology
University of Nebraska Medical Center
Omaha, Nebraska
Bhavana J. Dave, PhD
Human Genetics Laboratory, Munroe Meyer Institute for Genetics and Rehabilitation
University of Nebraska Medical Center
Omaha, Nebraska
Sandeep K. Rajan, MD
Department of Internal Medicine, Division of Hematology-Oncology
University of Nebraska Medical Center
Omaha, Nebraska
James O. Armitage, MD
Department of Internal Medicine, Division of Hematology-Oncology
University of Nebraska Medical Center
Omaha, Nebraska

Available Credit

  • 1.00 Participation
  • 1.00 Nurse
  • 1.00 Physician

Accreditation Period

Course opens: 
03/06/2015
Course expires: 
03/06/2016

Price

Cost:
$0.00
Please login or register to take this course.

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  • A device with an Internet connection
  • Adobe Reader or other PDF reader software for article and certificate viewing/printing