Combined immunoradiotherapy induces long-term remission of CNS relapse of peripheral, diffuse, large-cell lymphoma after allogeneic stem cell transplantation: Case study

Lotze, Christian; Schüler, Frank; Krüger, William; Hirt, Carsten; Kirsch, Michael; Vogelgesang, Silke; Schmidt, Christian A.; Dölken, Gottfried

doi:10.1215/s1152851705000256

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Unfortunately, a possible survival benefit with this strategy would be obscured by an elevated treatment-related mortality. In this scenario, a German case study on a patient allografted for systemic NHL with a favourable course has been reported [54]. On day þ83 after transplantation a CNS relapse of the lymphoma occurred.…”

Section: Allogeneic Stem-cell Transplantationmentioning

confidence: 99%

Central nervous system dissemination in immunocompetent patients with aggressive lymphomas: incidence, risk factors and therapeutic options

Ferreri

Assanelli²,

Crocchiolo³

et al. 2009

Hematological Oncology

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Central nervous system (CNS) dissemination is a rare (4-5%) but usually fatal complication of aggressive lymphomas. Prophylaxis modalities to prevent CNS dissemination in aggressive lymphomas cannot be widely applied to every lymphoma patient since it is associated with increased risk of neurotoxicity. Therefore, identification of high-risk patients as the best candidates to receive CNS prophylaxis constitutes a major endpoint in the management of these malignancies. Various risk factors and models for CNS recurrence have been described. Parameters reflecting the extent and proliferation of the disease, like elevated serum lactate dehydrogenase levels, involvement of multiple extranodal sites, advanced stage and high age-adjusted International Prognostic Index (IPI) score, as well as the involvement of specific anatomic sites, like testes, orbit, paranasal sinuses, have been identified and confirmed as important to predict CNS dissemination. Management of this complication in aggressive lymphomas with conventional-dose chemotherapy is associated with disappointing results, while some preliminary but encouraging experiences suggest a potential role of high-dose chemotherapy and stem cell transplantation. The analysis of recent clinical studies could lead to advancement in the prognosis of aggressive lymphomas, but several questions regarding the optimum chemotherapy combination, the best conditioning regimen and the role of radiation therapy and intrathecal chemotherapy remain still unanswered. The purposes of the present review are to critically analyse current data on the risk of CNS dissemination in aggressive lymphomas, the clinical presentation of secondary CNS lymphomas and the efficacy of CNS prophylaxis as well as to discuss the available therapeutic options for this devastating event.

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Section: Allogeneic Stem-cell Transplantationmentioning

confidence: 99%

Central nervous system dissemination in immunocompetent patients with aggressive lymphomas: incidence, risk factors and therapeutic options

Ferreri

Assanelli²,

Crocchiolo³

et al. 2009

Hematological Oncology

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“…Furthermore, the successful treatment by allogeneic BSCT of patients with isolated CNS relapse of acute leukemia has been published [21]. In a prior publication we reported the successful therapy of CNS-relapse of high-grade NHL with alloSCT, immunomodulation and irradiation [22]. The clinical and molecular remission of SMZL in this case strongly suggest contribution of GvL-effects, however, the relative short follow-up of three years allows no definite conclusion.…”

Section: Discussionmentioning

confidence: 86%

Treatment of splenic marginal zone lymphoma of the CNS with high-dose therapy and allogeneic stem cell transplantation

Busemann¹,

Gudzuhn²,

Hirt³

et al. 2012

Exp Hematol Oncol

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Therapy of indolent lymphomas with involvement of the central nervous system (CNS) has not been standardized so far. A 42-year old male patient presented with neurological signs because of leukemic splenic marginal zone lymphoma (SMZL) manifested in bone marrow, lymph nodes and CNS. Due to the aggressiveness of the disease and the young age of the patient, an intensive immunochemotherapy followed by high-dose therapy with busulfan, thiotepa and fludarabine and subsequent unrelated allogeneic stem cell transplantation (alloSCT) was performed. The haemopoietic stem cells engrafted in time and the patient is doing well (ECOG 0) without evidence for active lymphoma three years after transplantation. Highly sensitive tests by specific quantitative real-time polymerase chain reaction for presence of lymphoma cells in blood and bone marrow indicated also a molecular remission. The reported case shows the feasibility of high-dose therapy and allogeneic stem cell transplantation in high-risk patients with CNS-involvement of indolent non-Hodgkin’s lymphoma. In addition, the case supports the hypothesis that the graft-versus lymphoma effect after alloSCT is also active within the CNS.

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“…A comparable finding has also been reported in a patient with a cerebral relapse of high-grade malignant lymphoma after an allogeneic transplant. 3 To our knowledge, this is the first case of a vHCL that showed an intra-abdominal tumorous (chloroma-like) relapse after allogeneic transplantation. It has to be pointed out that this relapse occurred in the presence of a limited chronic GvHD.…”

mentioning

confidence: 75%

Late extramedullary relapse after allogeneic transplantation in a case of variant hairy cell leukaemia

Busemann

Schüler

Krüger

et al. 2009

Bone Marrow Transplant

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Combined immunoradiotherapy induces long-term remission of CNS relapse of peripheral, diffuse, large-cell lymphoma after allogeneic stem cell transplantation: Case study

Cited by 7 publications

References 8 publications

Central nervous system dissemination in immunocompetent patients with aggressive lymphomas: incidence, risk factors and therapeutic options

Central nervous system dissemination in immunocompetent patients with aggressive lymphomas: incidence, risk factors and therapeutic options

Treatment of splenic marginal zone lymphoma of the CNS with high-dose therapy and allogeneic stem cell transplantation

Late extramedullary relapse after allogeneic transplantation in a case of variant hairy cell leukaemia

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