Patient History

This 48 year-old woman was referred for further management of a refractory lymphoproliferative disorder. Her diagnosis came at the age of 46 when her primary care physician evaluated an upper respiratory illness. She initially received a fludarabine-based regimen with little or no response. At this point she was given cyclophosphamide, vincristine, prednisone and rituximab for 6 cycles. Follow-up evaluation documented increasing lymphocytosis and recurrent lymphadenopathy including cervical, axillary, inguinal and retroperitoneal lymph nodes. Two years following diagnosis, she received alemtuzumab (anti-CD52) followed by R-CHOP (rituximab, dolasetron, prednisone, cyclophosphamide, doxorubicin and vincristine). Her lymphadenopathy responded, but her peripheral blood absolute lymphocytosis increased. Currently, she presents for evaluation and treatment of refractory disease. Blood, bone marrow aspirate and biopsy, and cytogenetics are available for examination.