Complete metabolic remission in an 84-year old patient with relapsed/refractory diffuse large B-cell lymphoma following
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LETTER TO THE EDITOR
Complete metabolic remission in an 84‑year old patient with relapsed/ refractory diffuse large B‑cell lymphoma following combination immunotherapy with lenalidomide plus rituximab Ciprian Tomuleasa1,2 · Sabina Iluta1,2 · Sergiu Pasca1 · Andrei Roman3,4 · Doina Piciu3,4 · Ciprian Jitaru1 · Patric Teodorescu1,2 · Ioana Rus1,2 · Anca Bojan1,2 · Delia Dima1 · Mihnea Zdrenghea1,2 · Bobe Petrushev5 Received: 1 July 2020 / Accepted: 27 August 2020 © Japanese Society of Hematology 2020
Dear Editor, We have read with great interest the paper of Izutsu et al., referring to the data of the AUGMENT phase III clinical trial that report the benefit of lenalidomide plus rituximab (R-Len) for relapsed refractory indolent B-cell non-Hodgkin lymphomas (B-NHL) [1]. The work from the National Cancer Center in Tokyo is very exciting. Still, indolent NHL are not the only cases where R-Len combination therapy might be of potential use, with aggressive lymphomas also benefiting from this alternative. Diffuse large B-cell lymphoma (DLBCL) is the most frequent B-NHL, accounting for approximately 30–40% of B-NHL [2]. The standard first line of therapy for this malignancy is represented by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) with the option of eliminating doxorubicin from the regimen in the case of patients with severe cardiovascular comorbidities This comment refers to the article available online at https://doi. org/10.1007/s12185-019-02802-y. * Ciprian Tomuleasa [email protected] 1
Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj‑Napoca, Romania
2
Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Gheorghe Marinescu Street, 400124 Cluj‑Napoca, Romania
3
Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca, Cluj‑Napoca, Romania
4
Department of Radiology,, Ion Chiricuta Clinical Cancer Center, Cluj‑Napoca, Romania
5
Medfuture Research Center, Iuliu Hatieganu University of Medicine and Pharmacy Cluj Napoca, Cluj‑Napoca, Romania
[3]. Nonetheless, there is an important percent of people that relapse or do not respond after R-CHOP, thus needing to start the next line of chemotherapy. Some patients, especially elderly ones, are unfit for additional chemotherapy or for hematopoietic bone marrow transplant. Thus, clinicians prefer to use palliative care in these cases, for example R-Len [4]. In the current manuscript, we present the case of a relapsed elderly DLBCL patient that reached metabolic remission after R-Len. The patient presented with NYHA III congestive heart failure, persistent atrial fibrillation,and chronic cardiac ischemia, as well as asthenia, fatigue, night sweats, weight loss and latero-cervical adenopathy.The pathology diagnosis was stage IV DLBLC. We decided to initiate six cycles of the R-COPregimen. After those, the PET-CT performed revealed a left para-aortic adenopathy with Deauville score 5, pleading for persistent disease (Fig. 1a). The se
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