A rare case of appendicular skeleton localization in a patient with Chronic Lymphocytic Leukemia (CLL) successfully treated with salvage radiotherapy

Abstract Bone involvments by Chronic Lymphocytic Leukemia (CLL) are considered rare events and English Medical Literature describes them only in sporadic case reports. Consequently robust indications for a rational clinical management are lacking. We report the case of a middle age man in clinical follow-up for a CLL who complained about a Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) refractory pain at right tibial level and an acute episode of anemia. Instrumental exams and a bioptic sample surprisingly demonstrated a bone tibial localization by CLL. After an attempt to control the disease through a pharmacologic approach with Rituximab and Bendamustine ( one cycle executed), interrupted due to a prolonged thrombocytopenia, the patient was successfully managed with an Involved Site Conformal Radiotherapy. A complete metabolic response has been demonstrated 3 months after the end of radiotherapy. and it’s still present after a long follow-up of more than 15 months.