TABLE 4.

B-Cell Prolymphocytic Leukemia Cases

Case No.	Age, y/Sex	Panel diagnosis	Interesting features
256	66/M	Consistent with B-PLL	Morphologic features suggestive of B-PLL, unusual immunophenotype. Bone marrow presentation is clonally related to blastoid proliferation seen in lymph nodes.
66	68/M	B-PLL	Presentation with both peripheral blood and lymph node involvement. Complex karyotype with t(8;22)(q24;q11.2), trisomy 12, gains of BCL2 and BCL6, and MYC variant.
201	59/F	B-PLL with clonal evolution and acquired resistance to ibrutinib	Morphologic progression to large cell morphology and clonal evolution with increased VAF of TP53 R248W, MYD88 L265P (along with increased copy number), and TP63 R337Q and acquisition of several mutations enhancing BCR signaling, proliferation, and conferring BTK resistance (BTK C481S). Decreased CD58 expression seen late in the disease may be linked to immune evasion.

BCR, B-cell receptor; B-PLL, B-cell prolymphocytic leukemia; VAF, variant allele frequency.