Hočkinova varijanta transformacije hronične limfocitne leukemije/limfoma malih limfocita
Sažetak
Uvod. Hronična limfocitna leukemija (HLL)/limfom malih limfocita se u retkim slučajevima može transformisati u Hočkinov limfom, a u literaturi je do sada opisano oko sto ovakvih slučajeva. Prikazujemo bolesnika sa Hočkinovom varijantom Rihterove transformacije. Prikaz bolesnika. Godinu dana nakon početka kontrolnog praćenja, kod 60-godišnjeg muškarca sa HLL došlo je do razvoja B simptoma, generalizovane limfadenopatije i splenomegalije. Posle početnog određivanja stadijuma bolesti (Binet B/Rai 3), započeto je lečenje prema protokolu fludarabin, ciklofosfamid, rituksimab (FCR). Nakon trećeg ciklusa lečenja i dalje se održavala i postajala bolna, desnostrana pazušna limfadenopatija, dok su se dimenzije preostalih, bolešću zahvaćenih organa, smanjile. Po okončanju poslednjeg, šestog ciklusa FCR terapije, bolna desnostrana pazušna limfadenopatija se održavala (iako se delimično smanjila u veličini), sa razvojem lokalnog crvenila i otoka. Biopsijom zaostalog pazušnog nodusa dokazana je transformacija bolesti u Hočkinov limfom. Nakon određivanja stadijuma bolesti na osnovu nalaza multislajsne kompjuterizovane tomografije (IV E klinički stadijum) i procene prognoze (nepovoljna prognoza), odlučeno je da se lečenje nastavi prema protokolu doksorubicin, vinblastin, dakarbazin (AVD). Bolesnik je preminuo dva meseca nakon potvrde dijagnoze Hočkinove transformacije (HT), u toku sprovođenja prvog AVD. Zaključak. Mada je HLL sporo progresivna maligna bolest, u retkim slučajevima sa HT prognoza je nepovoljna. Dostupne terapijske mogućnosti daju suboptimalne rezultate, mada bi u skorijoj budućnosti inovativne imunološke terapije mogle izmeniti tok lečenja bolesnika sa HT.
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