{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T02:35:30Z","timestamp":1761100530254},"reference-count":27,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2002,4,29]],"date-time":"2002-04-29T00:00:00Z","timestamp":1020038400000},"content-version":"vor","delay-in-days":87,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2002,2]]},"abstract":"<jats:p><jats:bold>Abstract:<\/jats:bold> Novel therapeutic regimens containing purine analogs and monoclonal antibodies have led to significant improvement in the course of indolent lymphoproliferative diseases (LPD). Complete clinical and even molecular remissions have been achieved in an increasing proportion of patients. In parallel to their tumor cytotoxic effect, these agents are inevitably associated with prolonged immunosuppression inherent to their mechanism of antilymphocytic activity. Until now, attention has been paid mainly to opportunistic infection occuring as a result of the above drug\u2010induced immunosuppression and less to other possible complications, such as malignancy or tumor progression in the immunocompromised host. Here we briefly report nine patients with previously treated indolent LPD in whom the onset of large\u2010cell transformation occured during or shortly after the initiation of regimens containing these agents before transformation occured. One patient had received rituximab alone, three fludarabine\u2010containing regimens and five received sequential regimens containing both agents. This \u2018switch\u2019 in the histopathology could merely reflect the natural course of progressive lymphoma and be unrelated to the therapy given. The onset of this complication during, or so soon after, administration of these regimens seems to us more than just a chance relationship in these cases; however, we have no conclusive evidence to prove this hypothesis definitively. We draw attention to this phenomenon.<\/jats:p>","DOI":"10.1034\/j.1600-0609.2002.01599.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T18:52:16Z","timestamp":1047408736000},"page":"80-83","source":"Crossref","is-referenced-by-count":31,"title":["Large\u2010cell transformation of chronic lymphocytic leukemia and follicular lymphoma during or soon after treatment with fludarabine\u2013rituximab\u2010containing regimens: natural history\u2010 or therapy\u2010related complication?"],"prefix":"10.1111","volume":"68","author":[{"given":"Yossi","family":"Cohen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nael","family":"Da'as","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Libster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail","family":"Amir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Berrebi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Polliack","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2002,4,29]]},"reference":[{"key":"e_1_2_4_2_2","first-page":"285","article-title":"Generalized reticular cell sarcoma of lymph nodes associated with lymphatic leukemia","volume":"4","author":"Richter MN","year":"1928","journal-title":"Am J Pathol"},{"key":"e_1_2_4_3_2","first-page":"117","article-title":"Chronic lymphocytic leukemia in (Richter's) transformation","volume":"25","author":"Giles FJ","year":"1998","journal-title":"Semin Oncol"},{"key":"e_1_2_4_4_2","first-page":"73","volume-title":"The Lymphoid Leukemias","author":"Catovski D","year":"1990"},{"key":"e_1_2_4_5_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1182\/blood.V80.1.29.29","article-title":"Response assessment in chronic lymphocytic leukemia after fludarabine plus prednisone. 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Current strategy and new perspectives of treatment","volume":"84","author":"Rai KR","year":"1999","journal-title":"Haematologica"},{"key":"e_1_2_4_15_2","first-page":"1525","article-title":"Rituximab therapy in Waldenstrom's macroglobulinemia: preliminary evidence of clinical activity","volume":"12","author":"Byrd JC","year":"2001","journal-title":"Ann Oncol"},{"key":"e_1_2_4_16_2","doi-asserted-by":"crossref","unstructured":"CohenY PolliackA ZeligO GoldfarbA.Monotherapy with rituximab induces rapid remission of recurrent cold agglutinin\u2010mediated hemolytic anemia in a patient with indolent lympho\u2010plasmacytic lymphoma.Leuk Lymph2001;42(6).","DOI":"10.3109\/10428190109097770"},{"key":"e_1_2_4_17_2","first-page":"732a","article-title":"Molecular eradication of the BCL2\/IgH gene after sequential therapy with CHOP and anti\u2010CD20 (rituximab) monoclonal antibody in previously untreated follicular NHL patients","volume":"96","author":"Rambaldi A","year":"2000","journal-title":"Blood"},{"key":"e_1_2_4_18_2","doi-asserted-by":"publisher","DOI":"10.3109\/10428199909145966"},{"key":"e_1_2_4_19_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1200\/JCO.1995.13.9.2431","article-title":"Infectious and immunosuppressive complications of purine analog therapy","volume":"13","author":"Cheson BD","year":"1995","journal-title":"J Clin Oncol"},{"key":"e_1_2_4_20_2","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1200\/JCO.1998.16.4.1635","article-title":"Peripheral T\u2010cell lymphoma after anti\u2010CD20 antibody therapy","volume":"16","author":"Tetreault S","year":"1998","journal-title":"J Clin Oncol"},{"key":"e_1_2_4_21_2","first-page":"173","article-title":"The pathology of post\u2010transplant lymphoproliferative disorders occurring in the setting of cyclosporine A \u2013 prednisone immunosuppression","volume":"133","author":"Nalesnik MA","year":"1988","journal-title":"Am J Pathol"},{"key":"e_1_2_4_22_2","first-page":"429a","article-title":"Fludarabine therapy may precipitate large cell transformation in chronic lymphocytic leukemia but not in follicular lymphoma","volume":"92","author":"Pocock C","year":"1998","journal-title":"Blood"},{"key":"e_1_2_4_23_2","first-page":"295b","article-title":"Fludarabine (FAMP) and risk of occurance of Richter's syndrome among B\u2010CLL","volume":"96","author":"Tabuteau S","year":"2000","journal-title":"Blood"},{"key":"e_1_2_4_24_2","doi-asserted-by":"publisher","DOI":"10.3109\/10428190109099341"},{"key":"e_1_2_4_25_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.8.2454"},{"key":"e_1_2_4_26_2","first-page":"1985","article-title":"Richter's syndrome. A report on 39 patients","volume":"11","author":"Robertson LE","year":"1993","journal-title":"Clin Oncol"},{"key":"e_1_2_4_27_2","first-page":"539a","article-title":"Transformation to Richter's syndrome or prolymphocytic leukemia (PLL), and other second hematologic malignancies in patients with chronic lymphocytic leukemia (CLL). 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