Transformation of diffuse large B-cell lymphoma into pre-B acute lymphoblastic leukemia: clinicopathologic features and clonal relationship

Hum Pathol. 2004 Jul;35(7):900-3. doi: 10.1016/j.humpath.2004.04.002.


A patient with fibrosing alveolitis developed a diffuse large B-cell (DLBC) lymphoma that expressed CD20 and CD30. After an initial response, the lymphoma relapsed and was salvaged with further chemotherapy. After another remission of 3 years, a pre-B-cell acute lymphoblastic leukemia (ALL), which expressed CD10, CD19, CD22, CD79a, CD34 and terminal deoxyribonucleotidyl transferase, developed and led to death. Molecular analysis of the immunoglobulin heavy-chain gene showed that the initial lymphoma and its relapse were clonally related. At leukemic relapse, 2 clones related to the initial and relapsed lymphoma clones were present. DLBC lymphomas arise from post-follicle center B cells, whereas ALL arises from pregerminal B cells. Therefore, a direct transformation of DLBC lymphoma to ALL appears unlikely. The overall features suggest instead separate lymphoma and leukemic evolution from a common mutated B-cell precursor rather than transformation of DLBC lymphoma to ALL.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Base Sequence
  • Burkitt Lymphoma / drug therapy
  • Burkitt Lymphoma / genetics
  • Burkitt Lymphoma / pathology*
  • Cell Transformation, Neoplastic / genetics
  • Cell Transformation, Neoplastic / pathology*
  • Clone Cells
  • DNA, Neoplasm / analysis
  • Fatal Outcome
  • Female
  • Humans
  • Immunophenotyping
  • In Situ Hybridization
  • Karyotyping
  • Lymphoma, B-Cell / drug therapy
  • Lymphoma, B-Cell / genetics
  • Lymphoma, B-Cell / pathology*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / genetics
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Molecular Sequence Data
  • Neoplasms, Second Primary
  • RNA, Neoplasm / analysis
  • RNA, Viral / analysis
  • RNA-Binding Proteins / analysis
  • Ribosomal Proteins / analysis


  • DNA, Neoplasm
  • RNA, Neoplasm
  • RNA, Viral
  • RNA-Binding Proteins
  • Ribosomal Proteins
  • RPL22 protein, human