Richter syndrome: chronic lymphocytic leukemia transformation into Hodgkin's disease.

r ichter syndrome is a clinical condition in which indolent chronic lymphocytic leukemia evolves into a more aggressive diffuse large B cell lymphoma. Maurice Nethaniel Richter first described this phenomenon in 1928, which was named the “Richter syndrome” in 1964 [1]. Due to the aggressive nature of the disorder, the clinical manifestations, prognosis and treatment differ from CLL1 [2]. Symptoms will usually include lymphadenopathy, the appearance of “B symptoms” and elevated levels of serum lactate dehydrogenase [2]. The incidence of Richter syndrome originating from CLL to diffuse large B cell lymphoma ranges between 2% and 8% of CLL patients [3]. Although uncommon, approximately 0.4% of CLL patients will experience transformation into Hodgkin’s disease [3]. In the current communication we report on such an occurrence and elaborate on the possible effect of fludarabine therapy on this association.