There is mounting evidence that leukemic presentation portends a worse prognosis in patients with FL in leukemic phase.The presence of circulating lymphoma cells in FL is a rare event and is associated with shorter PFS Median progression-free survival independently of FLIPI score and β2-m level. It can be safely said that circulating lymphoma cells >4.109/L have a poorer outcome. Although ~1/3 of the patients experience long term PFS, these should be monitored carefully during and after first line treatment to consider HSCT. Follicular Lymphoma presenting as B-ALL at diagnosis is a independent risk factor & has a poor prognostic outcome because it is highly aggressive tumour. The very rare nature of this entity & its grave prognosis merits its reporting.