There is also an increased risk of RT-DLBCL in CLL with NOTCH1 mutations, bulky lymphadenopathy, and on PET-CT SUV > 5 in tumor masses, but the risk of developing RT-DLBCL is unrelated to any specific prior therapy of CLL [1, 2, 5, 6]. This evidence concerns the gene NOTCH1 and B-cell chronic lymphocytic leukemia.