Zeitschrift für Hämatologie und thromboembolische Erkrankungen
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An Aggressive Transformation to EBV-Positive Hodgkin Lymphoma after Bendamustine-Containing Chemotherapy for Marginal Zone Lymphoma

Nakazawa H, Sakai H, Kawakami T, Hirabayashi Y, Nakazawa K, et al.

EBV-positivelymphoproliferative disorders are well documented phenomenon after fludarabine therapy. Although bendamustine shares common chemical structure with fludarabine, therapy-related malignancies have rarely been reported. A seventy-three-year-old man was presented with splenomegaly and pharyngeal mass. The biopsies of bone marrow and the mucosal mass revealed he had splenic marginal zone lymphoma, stage IV. Six months later, he received one course of R-CHOP and splenectomy. Three months after the surgery, the lymphoma progressed with massive pleural effusion, and six courses of bendamustine plus rituximab, yielding minimal response of the disease. Six months after the completion of bendamustine, however, Pel-Ebstein-like fever and progression of lymphadenopathy ensued. A lymph node biopsy exhibited he had EBV-positive classical Hodgkin lymphoma concomitant with marginal zone lymphoma. The patient achieved complete response after brentuximab vedotin therapy. The Hodgkin lymphoma in the present case might be a result of an aggressive transformation of marginal zone lymphoma, and it could be speculated that the purine analogue-like property of bendamustine be associated with the transformation.