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Follicular lymphoma presenting as hyperleucocytosis
Heidi A Worth1, Katherine Cochrane2, David Aljadir2
1Department of Medicine, University of Tennessee Knoxville, Knoxville, Tennessee, USA hworth@utmck.edu.
Follicular lymphoma rarely presents with hyperleukocytosis, a condition associated with poor prognosis. This rare presentation of follicular lymphoma with extreme leukocytosis indicates a need to re-evaluate prognostic tools.
Area of Science:
- Hematology
- Oncology
Background:
- Follicular lymphoma (FL) is the second most common non-Hodgkin's lymphoma in adults, typically presenting as indolent lymphadenopathy.
- Hyperleukocytosis at diagnosis is an exceedingly rare clinical manifestation of FL.
Observation:
- A case report details a 63-year-old woman with FL presenting with hyperleukocytosis (1,327,000/μL).
- Diagnostic workup included fluorescence in situ hybridization (FISH), confirming FL with BCL2 positivity and no MYC rearrangement.
Findings:
- The patient received cytoreductive therapy with rituximab-containing agents.
- Despite treatment, the patient ultimately expired, highlighting a poor outcome associated with this leukaemic presentation.
Implications:
- The leukaemic phase of FL at presentation appears to correlate with a significantly worse prognosis.
- Current prognostic models, such as the Follicular Lymphoma International Prognostic Index (FLIPI), do not incorporate leukocytosis, suggesting a need for revision.
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