Herein, we describe a case of a female patient in whom B cell chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) were diagnosed simultaneously. She presented with anemia, thrombocytopenia and splenomegaly. Flow cytometry demonstrated two immunophenotypically distinct CD5-positive monoclonal B cell populations. Peripheral blood fluorescence in situ hybridization (FISH) was positive for IGH/CCND1, consistent with t(11;14) translocation. She received 6 cycles of bendamustine 70 mg/m2/day for 2 days and rituximab on the first day every 4 weeks along with granulocyte-colony stimulating factor. She had an excellent response, and repeat computed tomography after her third cycle of chemotherapy revealed no organomegaly or lymphadenopathy. Her peripheral blood lymphocytosis also resolved. Bone marrow examination revealed no detectable flow-cytometric evidence of MCL or CLL. Repeat cytogenetic and FISH analysis were also normal. The patient remains in complete remission 20 months after her initial diagnosis and is receiving maintenance rituximab 375 mg/m2 weekly for 4 weeks every 6 months for 2 years.

Keywords:
Bendamustine, Mantle cell lymphoma, Small lymphocytic lymphoma
1.
Lima M, Pinto L, Teixiera MDJ, Canelhas A, Mota A, Cabeda JM, Silva C, Queiros ML, Fonseca S, Santos AH, Brochado P, Justica B: Guess what: chronic 13q14.3+/CD5–/CD23+ lymphocytic leukemia in blood and t(11;14)(q13;q32)+/CD5+/CD23– mantle cell lymphoma in lymph nodes. Cytometry B Clin Cytomet 2003;51:41–44.
2.
Addada J, Anoop P, Swansbury JG, Wotherspoon A, Thomas JM, Matutes E: Synchronous mantle cell lymphoma, chronic lymphocytic leukemia and melanoma in a single lymph node. Acta Haematol 2010;123:194–196.
3.
Kahl BS, Longo WL, Eickhoff JC, Zehnder J, Jones C, Blank J, McFarland T, Bottner W, Rezazedeh H, Werndl J, Bailey HH: Wisconsin Oncology Network. Maintenance rituximab following induction chemoimmunotherapy may prolong progression-free survival in mantle cell lymphoma: a pilot study from the Wisconsin Oncology Network. Ann Oncol 2006;17:1418–1423.
4.
Kath R, Blumenstengel K, Fricke HJ, Hoffken K: Bendamustine monotherapy in advanced and refractory chronic lymphocytic leukemia. J Cancer Res Clin Oncol 2001;127:48–54.
5.
Bergmann MA, Goebeler ME, Herold M, Emmerich B, Wilhelm M, Ruelfs C, Boening L, Hallek MJ: German CLL Study Group. Efficacy of bendamustine in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase I/II study of the German CLL Study Group. Haematologica 2005;90:1357–1364.
6.
Lissitchkov T, Amaudov G, Peytchev D, Merkle Kh: Phase I/II study to evaluate dose limiting toxicity, maximum tolerated dose, and tolerability of bendamustine HCl in pre-treated patients with B-chronic lymphocytic leukaemia (Binet stages B and C) requiring therapy. J Cancer Res Clin Oncol 2006;132:99–104.
7.
Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, Juliusson G, Postner G, Gercheva L, Goranov S, Becker M, Fricke HJ, Del Giudice I, Klein P, Merkle K, Montillo M: Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol 2009;27:4378–4384.
8.
Rummel MJ, Al-Batran SE, Kim SZ, Welslau M, Hecker R, Kofahl-Krause D, Josten KM, Durk H, Rost A, Neise M, von Grunhagen U, Chow KU, Hansmann ML, Mitrou PS: Bendamustine plus rituximab is effective and has a favorable toxicity profile in the treatment of mantle cell and low-grade non-Hodgkin’s lymphoma. J Clin Oncol 2005;23:3383–3389.
9.
Robinson KS, Williams ME, van der Jagt RH, Cohen P, Herst JA, Tulpule A, Schwartzberg LS, Lemieux B, Cheson BD: Phase II multicenter study of bendamustine plus rituximab in patients with relapsed indolent-B-cell and mantle cell non-Hodgkin’s lymphoma. J Clin Oncol 2008;26:4473–4479.
10.
Ohmachi K, Ando K, Ogura M, Uchida T, Itoh K, Kubota N, Ishizawa K, Yamamoto J, Watanabe T, Uike N, Choi I, Terui Y, Usuki K, Nagai H, Uoshima N, Tobinai K: The Japanese Bendamustine Lymphoma Study Group. Multicenter phase II study of bendamustine for relapsed or refractory indolent B-cell non-Hodgkin lymphoma and mantle cell lymphoma. Cancer Sci 2010;101:2059–2064.
11.
Hallek M, Cheson BD, CatovskyD, Caligaris-Cappio F, Dighiero G, Dohner H, Hillmen P, Keating MJ, Montserrat E, Rai KR, Kipps TJ: International Workshop on Chronic Lymphocytic Leukemia. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008;111:5446–5456.
12.
Zenz T, Eichhorst B, Busch R, Denzel T, Habe S, Winkler D, Buhler A, Edelmann J, Bergmann M, Hopfinger G, Hensel M, Hallek M, Dohner A, Stilgenbauer S: TP53 mutation and survival in chronic lymphocytic leukemia. J Clin Oncol 2010;28:4473–4479.
13.
Roue G, Lopez-Guerra M, Milpied P, Perez-Galan P, Villmor N, Montserrat E, Campo E, Colomer D: Bendamustine is effective in p53-deficient B-cell neoplasms and requires oxidative stress and caspase-independent signaling. Clin Cancer Res 2008;14:6907–6915.
14.
Chanan-Khan A, Miller KC, Musial L, Lawrence D, Padmanabhan S, Takeshita K, Porter CW, Goodrich DW, Bernstein ZP, Wallace P, Spaner D, Mohr A, Byrne C, Hernandez-Ilizaliturri F, Chrystal C, Starostik P, Czuczman MS: Clinical efficacy of lenalidomide in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase II study. J Clin Oncol 2006;24:5343–5349.
15.
Habermann TM, Lossos IS, Justice G, Vose JM, Wiernik PH, McBride K, Ervin-Haynes A, Takeshita K, Pietronigro D, Zeldis JB, Tuscano JM: Lenalidomide oral monotherapy produces a high response rate in patients with relapsed or refractory mantle cell lymphoma. Br J Haematol 2009;145:344–349.
16.
Lin TS, Blum KA, Fischer DB, Mitchell SM, Ruppert AS, Porcu P, Kraut EH, Baiocchi RA, Moran ME, Johnson AJ, Schaaf LJ, Grever MR, Byrd JC: Flavopiridol, fludarabine, and rituximab in mantle cell lymphoma and indolent B-cell lymphoproliferative disorders. J Clin Oncol 2010;28:418–423.
17.
Cheson BD, Wendtner CM, Pieper A, Dreyling M, Friedberg J, Hoelzer D, Moreau P, Gribben J, Knop S, Montillo M, Rummel M: Optimal use of bendamustine in chronic lymphocytic leukemia, non-Hodgkin lymphomas, and multiple myeloma: treatment recommendations from an international consensus panel. Clin Lymphoma Myeloma Leuk 2010;10:21–27.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.