FIGURE 2.

Clinical course from the initial diagnosis to Richter transformation 1 year after the disease onset, chronic lymphocytic leukemia (CLL) required treatment and ibrutinib (IBR) was initiated. After IBR initiation, the markers and del17p showed signs of improvement; however, during the treatment, CLL transformed into Richter transformation. Consequently, the markers and del17p worsened again. At this time, a biopsy of the lymph node tissue revealed the acquisition of a PLCG2 mutation. Upon reducing the IBR dose and commencing venetoclax (VEN), the lymphadenopathy exhibited improvement, but the tumor markers worsened. Subsequently, the IBR dose was reinstated, and VEN treatment continued, resulting in improvement. An additional dose of RIT was administered, leading the patient to achieve complete remission.