Chronic lymphocytic leukaemia presenting as a blast cell crisis

A man presented with a short history suggestive of anaemia and thrombocytopenia. Haematological investigations showed him to have an absolute peripheral lymphocytosis and the bone marrow was almost totally replaced by lymphoid blasts. A lymph node biopsy was interpreted as showing immunoblastic lymphoma supervening on chronic lymphocytic leukaemia. Cell surface marker studies performed on cells from peripheral blood and the excised lymph node demonstrated that the lymphocytes and blast cells carried the same surface monoclonal immunoglobulin and expressed OKT1/Leu I positivity. He was treated with a cytotoxic regimen for adult acute lymphoblastic leukaemia but did not respond. This appears to be the first report of a patient with chronic lymphocytic leukaemia who presented at the time of immunoblastic crisis.