Successful myeloablative unrelated bone marrow transplantation for relapsed intravascular large B cell lymphoma after au
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LETTER TO THE EDITOR
Successful myeloablative unrelated bone marrow transplantation for relapsed intravascular large B cell lymphoma after autologous peripheral blood stem cell transplantation Yoko Miura 1 & Jun Ooi 1 & Takuji Matsuo 1 & Tadashi Yamamoto 1 & Ritsu Sumiyoshi 1 & Sumiko Saito 1 & Kensuke Matsumoto 1 & Haruko Tashiro 1 & Naoki Shirafuji 1 Received: 30 September 2020 / Accepted: 17 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Intravascular large B cell lymphoma (IVLBCL) is a rare type of diffuse large B cell lymphoma (DLBCL) that is characterized by extranodal disease, with infiltration and proliferation of lymphoma cells within blood vessels. Clinically, three types of variants have been described: classical variant, cutaneous variant, and hemophagocytic syndrome–associated variant [1]. Although clinical outcomes have been improved with rituximab-containing chemotherapy [2], the long-term survival of IVLBCL patients is inferior to non-intravascular DLBCL patients. Autologous hematopoietic stem cell transplantation (auto-SCT) has also been performed as one of first-line therapies for IVLBCL patients [3]. However, auto-SCT is still associated with a risk of relapse. Patients who relapse after autoSCT have a poor outcome, and the optimal treatment for those patients remains unclear. Several reports of allogeneic stem cell transplantation (allo-SCT) in the treatment of DLBCL relapsing after auto-SCT have been published [4]. However, there have been no reports detailing the IVLBCL patients treated with alloSCT. We report here a patient with relapsed IVLBCL after auto-SCT who was successfully treated with myeloablative unrelated bone marrow transplantation (BMT). The patient was a 58-year-old male with fever of unknown origin. He was diagnosed with IVLBCL via random skin biopsy in November 2012. The lymphoma cells showed a high Ki67 expression (90%), and were positive for CD20 and Bcl-2, and negative for CD3, CD5, CD10, and CD30. The serum lactate dehydrogenase (LDH) level was elevated (740 U/L). Bone marrow aspirate showed hemophagocytosis (Fig. 1a, b).
* Jun Ooi [email protected] 1
Department of Hematology/Oncology, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8606, Japan
Magnetic resonance imaging of the brain showed several hyperintense lesions including the pons on T2-weighted images, which suggested vascular occlusion with lymphoma cells. After four courses of rituximab combined with hyper-CVAD/MA (rituximab plus hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with rituximab, high-dose methotrexate, and cytarabine) chemotherapy and intrathecal chemotherapy, the patient achieved a complete remission. High-dose chemotherapy (busulfan 3.2 mg/kg × 3 days, etoposide 400 mg/m2 × 2 days, and cyclophosphamide 50 mg/kg × 2 days) followed by autologous peripheral blood stem cell transplantation (auto-PBSCT) was performed in October 2013, and 9 months after the auto-PBSCT relapse was c
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