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Lymphoma relapse and lack of drug effect: 2 case reports A case report described a 66-year-old woman, who experienced a relapse of lymphoma during treatment with ruxolitinib and exhibited lack of efficacy during treatment with alemtuzumab and anakinra for haemophagocytic lymphohistiocytosis (HLH), and a 24-year-old man, who experienced a relapse of diffuse large B-cell lymphoma (DLBCL) during treatment with ruxolitinib for HLH [not all dosages and outcomes stated; routes and durations of treatments to reactions onsets not stated]. Case 1: The 66-year-old woman was admitted to hospital with fever, hypoxaemia and renal failure. She was empirically treated for sepsis, but infection was subsequently ruled out based on laboratory test. As her clinical course worsened, a diagnosis of HLH was made based on six of the eight HLH 2004 criteria. On day 14, she started receiving treatment with dexamethasone and etoposide. Her bone marrow exam also revealed a population of atypical CD30+cells and a hyperdiploid clone with a complex karyotype. Consequently, she was diagnosed with lymphoma associated HLH (LA-HLH). On day 67 of admission, her HLH resolved. Thus, she started receiving lymphoma-targeted therapy with bendamustine and brentuximab vedotin. Her lymphoma subtype was difficult to determine due to relative rarity of the malignant cells and the lack of architecture usually seen in a lymph node. She was treated with a Hodgkin’s treatment [details not stated] due to her CD30+status. However, after two months of this therapy, her HLH relapsed. A repeat bone marrow biopsy showed no evidence of lymphoma. Therefore, she started receiving treatment with ruxolitinib 10mg BID, which was then titrated to 15mg BID. Within 36 hours of starting ruxolitinib, she became afebrile. All of the HLH criteria, except spleen size and natural killer (NK) cells function, resolved within 2 weeks. She re-started lymphoma therapy. She finished lymphoma therapy and had a complete response of her HLH symptoms. During ruxolitinib taper, she again presented with relapsed HLH. She was taking 2.5mg a day at that time. A PET CT scan showed relapsed lymphoma. However, it was not confirmed on a bone marrow biopsy. The lymphoma relapse was considered secondary to treatment with ruxolitinib. Thereafter, she started receiving treatment with alemtuzumab and anakinra to control her HLH. However, the therapy with alemtuzumab and anakinra was unsuccessful. She died a little more than a year after her initial diagnosis [cause of death not stated]. Case 2: The 24-year-old man presented with fever, lymphadenopathy and pancytopenia. A Lymph node biopsy showed DLBCL. On admission, he was diagnosed with LA-HLH and started receiving treatment with rituximab, prednisone, etoposide, vincristine, cyclophosphamide and doxorubicin (R-EPOCH regimen), which was transitioned to rituximab, prednisone, vincristine, cyclophosphamide and doxorubicin (R-CHOP regimen) after 3 cycles. He completed total 6 cycles and had a complete response. Approximately 6.5 months after the diagnos