Isolated limb infusion with cytotoxic agent for treatment of localized refractory cutaneous T-cell lymphoma

Abstract

We described a 57-yr-old male diagnosed with cutaneous T-cell lymphoma that had failed multiple treatment options, as his disease was mainly confined to one limb. We attempted a novel approach in this condition using a technique of intra-arterial limb infusion with cytotoxic agent Melphalan (ILI) which has been proven beneficial in management of localised malignant melanoma. This treatment approach was well tolerated with mild myelosuppression and moderate limb toxicity. However, a significant improvement has been noted in the affected limb. This case demonstrated the successful use of isolated limb infusion with Melphalan in the management of localised cutaneous T-cell lymphoma. However, this result needs to be confirmed and further study is recommended. We are unaware there have been similar cases reported in the literature.

Isolated Limb Perfusion with Melphalan for the Treatment of Intractable Primary Cutaneous Diffuse Large B-Cell Lymphoma Leg Type

“…Therefore, two techniques are available: the isolated limb perfusion and the isolated limb infusion. Both were found to be effective in the present setting [16,17], and both show similar results, although the infusion technique is reserved for more distal tumors and do not require a long operation procedure, as collateral veins are not clamped and the venous efflux is constantly discarded [16]. Isolated limb infusion could then possibly be more likely for patients unable to stand a prolonged anesthesia [14].…”

“…Previous case reports have already shown the effectivity of both hyperthermic isolated limb infusion and limb perfusion in low-grade B and T non-Hodgkin lymphoma (NHL) [15,16,17]. This report as well as previous results from other groups indicate that isolated limb perfusion with melphalan might represent an effective treatment of NHL of the lower leg, resulting in an average disease-free survival of 7 months [5,15,16,17]. These data are in line with the average disease-free survival reported in DLBCL leg type after first recurrence [2], as well as with our own experience with DLBCL leg type, even with the use of R-CHOP as first-line treatment.…”

“…Due to this limited recurrence pattern, local treatment might prove effective, as was seen in other cutaneous NHL [18]. Considering significant improvements in the patients’ quality of life due to a single treatment with little or no side effects associated with only a short hospital stay [15,16], we suggest early consideration of isolated limb perfusion. In addition, patients with a poor performance state could profit from a therapy which is performed only at a single occasion [14].…”

Isolated limb infusion: A review

“…Like ILP the primary indication for ILI is patients with inoperable in-transit melanoma of the extremity, while both isolation treatments are also of benefit for patients with advanced extremity sarcoma [14,23,24]. ILI is used successfully as well in patients with refractory warts of the hands [25], refractory chromoycosis [26], localized cutaneous T-cell lymphoma [27], squamous cell carcinoma, and Merkel cell carcinoma [19].…”

Isolated limb infusion with cytotoxic agents: A simplified approach for venous access

“…ILI is predominantly used to treat advanced melanoma with in-transit metastases but can also be used to treat Merkle cell tumors, diffuse B-cell lymphoma, cutaneous T-cell lymphoma, and soft-tissue sarcomas, [1][2][3] and, occasionally, even nononcologic conditions such as refractory verrucae vulgaris. 4 ILI evolved from the procedure known as isolated limb perfusion (ILP), a procedure that involved isolation of the limb's blood supply and perfusion with oxygenated blood and therapeutic agents.…”