A case of triple hit lymphoma and rapid deterioration

Abstract

Triple hit lymphomas (THL) comprise a rare, heterogenous group of lymphomas and like many B-cell lymphomas, chromosomal translocations are biologic and diagnostic hallmarks of disease. Traditionally referred to as a subset of double hit lymphomas (DHL) in literature, THLs characteristically involve chromosomal rearrangements of c-MYC, BCL-2, and BCL-6 oncogenes. Many case series of high-grade B-cell lymphoma, especially MYC/BCL2 double hit lymphoma, have been described in the literature, but relatively few cases of triple hit lymphoma have been reported. Additionally, without chemotherapy, triple hit lymphomas are known to have a rapid clinical course and poor prognosis compared to double hit lymphomas. Here we present a case of MYC/BCL2/BCL6 triple hit lymphoma in a patient previously diagnosed with marginal B-cell lymphoma at stage IIA after biopsy of intra-abdominal lymph nodes status post one treatment with rituximab and bendamustine. Unfortunately, this patient had a rapid decline and presumed central nervous system (CNS) infiltration and passed away within 30 days of diagnosis.