LARGE-CELL LYMPHOMA COMPLICATING PERSISTENT POLYCLONAL B-CELL LYMPHOCYTOSIS

persistent polyclonal B cell lymphocytosis (PPBL) is a rare lymphoprol iferative disorder of unclear natural history and its potential for B cell malignancy remains unknown. We describe the case of a 39-year-old female who presented with stage IV-B large cell lymphoma 19 years aft er an initial diagnosis of PPBL; her disease was rapidly fatal despite intensive chemotherapy and blood stem cell transplantation. Because w e had recently identified multiple bcl-2/lg gene rearrangements in blo od mononuclear cells of patients with PPBL, we sought evidence of this oncogene in this particular patient: bcl-2/Ig gene rearrangements wer e found in blood mononuclear cells but not in lymphoma cells. Owing to the possible role of Epstein-Barr virus (EBV) in the pathogenesis of PPBL, we also hypothesized our patient might have an EBV-related lymph oproliferative disorder. Despite serologies consistent with past expos ure to this virus, it was not found in lymphoma cells using a sensitiv e polymerase chain reaction technique. We conclude that non-Hodgkin's lymphoma may occur during the course of PPBL. However, longer follow-u p in more patients will be needed in order to better clarify the risk of hematologic malignancy in patients with PPBL.