TDT Positive High-Grade Lymphoma with Myc, BCL2 And BCL6 Rearrangements: a Review of Diagnosis and Treatment TDT POSITIVE HIGH-GRADE LYMPHOMA WITH MYC, BCL2 AND BCL6 REARRANGEMENTS.
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Keywords
Lymphoma, Leukemia, Diffuse Large B-cell Lymphoma, double/triple hit lymphoma, CAR T-cell therapy, terminal deoxynucleotidyl transferase
Abstract
In the modern era, classification of neoplasms not only depends on immunomorphological features but also on specific disease defining genetic events. Translocations/rearrangements of MYC/8q24 locus in combination with BCL-2 or BCL6 translocations (double/triple hit) are considered hallmarks of high-grade B-cell lymphoma (HGBL), a type of aggressive mature B-cell lymphoma. When cases with immature immunophenotype present with these rearrangements, establishment of diagnosis becomes very difficult. We herein report an unusual case of B-cell lymphoma that presented with immature morphology and immunophenotype with triple hit gene rearrangements. This case highlights the difficulty in classifying and appropriately treating these patients. The novel aspect of this case is the treatment and outcome with chimeric antigen receptor, or CAR T-cell therapy.
Keywords: high-grade Lymphoma, TDT, MYC, BCL6.
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Ishaq Asghar, MD, Ascension St. John Hospital
Pathology Resident, Department of Pathology, Ascension St. John Hospital
Laura Kohler, DO, Ascension St. John Hospital
Hematology Oncology Fellow, Department of Hematology and Oncology, Ascension St. John Hospital
Hosam Hakim, MD, Ascension St. John Hospital
Hosam Hakim, MD, Hematology Oncology Faculty, Department of Hematology and Oncology, Ascension St. John Hospital
Daniel Snower, MD, Ascension St. John Hospital
Faculty, Department of Pathology, Ascension St. John Hospital
Daniel Lebovic, MD, Ascension St. John Hospital
Hematology Oncology Faculty, Chief of Hematology and Oncology, Department of Hematology and Oncology, Ascension St. John Hospital