A RARE DETERMINATION OF SMALL LYMPHOCYTIC LYMPHOMA ASSOCIATED WITH UNFAVORABLE EVOLUTION AND REVIEW OF THE LITERATURE

Small lymphocytic lymphoma (SLL) is an indolent lymphoma. Hypercalcemia is rarely associated with this type of lymphoma and was reported as a Richter`s transformation sign of SLL in the literature. We report a case of a 64-year-old man, with many comorbidities, including cardiac and renal pathologies, known with hepatitis B. Small lymphocytic B lymphoma with genetic risk factors, such as TP53, 17p and unmutated IGHV was diagnosed by laterocervical node biopsy. During chemotherapy, the patient initially presented sciatic pain, leading to the suspicion of a new associated malignancy, but the lumbar MRI excluded osteolysis. A few weeks later, the patient presented with neurological symptoms and dangerous hypercalcemia and high levels of iPTH were discovered. Parathyroid determination was discovered and the second line therapy with Venetoclax- Rituximab was chosen, but unfavorable evolution was noted, with activated macrophage syndrome, disseminated intravascular coagulation and multiple organ dysfunction syndrome. The genetic risk factors and the presence of hypercalcemia are markers of negative prognosis and unfavorable evolution of the disease.