PMC5551464_01
Peripheral blood smear. The lymphoid cells are of intermediate to large size with a prominent nucleolus and cytoplasm protrusions (Wright-Giemsa, x1000).
CRIHEM2017-8563218.001.jpg
PMC5551464_01_CRIHEM2017-8563218.001.jpg
fig1
A peripheral blood film demonstrated marked lymphocytosis with variably sized lymphocytes having clumped chromatin and central nucleoli (Figure 1).
Response to idelalisib-rituximab started on day 0, ibrutinib started in month 6, and reduced-intensity conditioning allo-HSCT was performed in month 8. (a) Absolute lymphocyte count. (b) Platelet count, hemoglobin concentration, and spleen size (measured by CT scan/longest diameter).
CRIHEM2017-8563218.002.jpg
PMC5551464_01_CRIHEM2017-8563218.002.jpg
fig2
Treatment with idelalisib-rituximab led to a rapid resolution (within 2 months) of the lymphocytosis (3.8 x 109/L), accompanied by normalization of the Hb concentration (130 g/L) and platelet count (174 x 109/L) and resolution of the hepatosplenomegaly on CT (Figure 2). Six months after the transplant, counts of the lymphocytes, the neutrophils, and platelets and also the Hb concentration were within the normal range and no enlarged organs were detected on CT (Figure 2).