Post‐transplant hepatosplenic T‐cell lymphoma successfully treated with hyperCVAD regimen

Tey, Siok-Keen; Marlton, Paula; Hawley, Carmel M.; Norris, Debra; Gill, Devinder

doi:10.1002/ajh.21062

Cited by 28 publications

(25 citation statements)

References 21 publications

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“…Patients are often young males who present with a systemic illness with fever, enlarged liver and spleen, and cytopenias. This lymphoma has been reported in patients with an altered immune system, including Crohn's disease [44] and after renal transplantation [45,46]. In the absence of a high degree of suspicion, the diagnosis might be overlooked.…”

Section: Hepatosplenic T-cell Lymphomamentioning

confidence: 99%

The aggressive peripheral T‐cell lymphomas: 2015

Armitage

2015

American J Hematol

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Background: T‐cell lymphomas make up approximately 10%–15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia.Diagnosis: The diagnosis of aggressive peripheral T‐cell lymphoma (PTCL) is usually made using the World Health Organization classification. The ability of hematopathologists to reproducibly diagnosis aggressive PTCL is lower than that for aggressive B‐cell lymphomas, with a range of 72%–97% for the aggressive PTCLs.Risk Stratification: Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, positron emission tomography scans seem to be useful as they are in aggressive B‐cell lymphomas. The most commonly used prognostic index is the International Prognostic Index. The specific subtype of aggressive PTCL is an important risk factor, with the best survival seen in anaplastic large‐cell lymphoma—particularly young patients with the anaplastic lymphoma kinase positive subtype.Risk‐Adapted Therapy: Anaplastic large‐cell lymphoma is the only subgroup to have a good response to a CHOP‐like regimen. Angioimmunoblastic T‐cell lymphoma has a prolonged disease‐free survival in only ∼20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL‐not otherwise specified is not one disease. Anthracycline‐containing regimens have disappointing results, and a new approach is needed. Natural killer/T‐cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy‐containing regimens. Enteropathy‐associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy, although selected patients with enteropathy‐associated PTCL seem to benefit from intensive therapy. Am. J. Hematol. 90:666–673, 2015. © 2015 Wiley Periodicals, Inc.

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Section: Hepatosplenic T-cell Lymphomamentioning

confidence: 99%

The aggressive peripheral T‐cell lymphomas: 2015

Armitage

2015

American J Hematol

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“…To date, 36 cases of HSTCL have been reported in IBD patients (Kotlyar et al, 2011), mostly affecting young men and the prognosis has been invariably fatal. Despite treatment with chemotherapy and stem cell transplantation, median survival is only 11 months (Falchook et al, 2009) but novel treatment strategies have shown some promise in isolated cases (Jaeger et al, 2008, Tey et al, 2008. Diagnosis is made by liver, splenic or bone marrow biopsy exhibiting atypical medium-sized lymphoid cells with round nuclei, small distinct nucleoli, loosely condensed chromatin, moderate pale cytoplasm and particular immunophenotypic expression which will be discussed further (Swerdlow et al, 2008).…”

Section: Hepatosplenic T-cell Lymphomamentioning

confidence: 99%

“…It is interesting that, HSTCL has only been reported in a single non-IBD patient who received adalimumab for rheumatoid arthritis (Shale et al, 2008). Conversely, there are a number of case reports of patients developing HSTCL whilst on immunosuppression in the post-transplant setting (Roelandt et al, 2009, Tey et al, 2008, Steurer et al, 2002 where anti-TNF drugs are not used.…”

Section: Hstcl In Ibdmentioning

confidence: 99%

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

Prasad¹

2012

New Advances in the Basic and Clinical Gastroenterology

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“…Large prospective series did indicate a higher relapse rate and a poorer survival for PTCL than DLBCL [2,[5][6][7][8][9][10][11][12][13]. Various chemotherapy regimens have been tried out--such as MegaCHOP (intensive or higher dose of CHOP) with or without etoposide [14,15], epirubicin substituted for doxorubicin and addition of bleomycin (CEOP-B) [16], CMED (cyclophosphamide, etoposide, methotrexate, and dexamethasone) [17], CHOP or MegaCHOP/ESHAP (etoposide, cisplatin, cytarabine and prednisone) [18,19] and VCAP-AMP-VECP (vincristine, cyclophosphamide, doxorubicin, and prednisone (VCAP); doxorubicin, ranimustine, and prednisone (AMP); vindesine, etoposide, carboplatin, and prednisone (VECP)) [20]; fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone alternating with high doses of methotrexate and cytarabine (hyperCVAD) [21,22]--with no superior efficacy to CHOP except CMED at the expense of higher treatment toxicity. Gemcitabine-based chemotherapies are emerging and seem quite compromising [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

“…Fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone (hyperCVAD) alternating with high doses of methotrexate and cytarabine has been used in treating PTCL [21] but did not show favorable outcome than CHOP [22]. However, alemtuzumab in combination with hyperCVAD has not been evaluated before.…”

Section: Introductionmentioning

confidence: 99%

The Outcome of HyperCVAD Combined with Alemtuzumab for the Treatment of Aggressive T-Cell and NK-Cell Neoplasms

Kuan

Chang

Lau

et al. 2011

Indian J Hematol Blood Transfus

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We report our experience in using six cycles of hyperCVAD in combination with alemtuzumab for the treatment of aggressive T-cell and NK/T-cell neoplasms. Seven females and six males with the median age of 41 (range 18-60) diagnosed with T-cell acute lymphoblastic lymphoma and peripheral T-cell and NK/T-cell neoplasms (n PTCL = 6, n T-cell ALL = 3, n NK/T-cell neoplasms = 4) from 2006 to 2008 were treated with alemtuzumab-hyperCVAD regimen. A total of nine patients (69%) responded to the regimen, with seven achieved complete remission and two achieved partial remission. The median progression free survival and overall survival duration among the responders with complete remission were 12.9 and 24.9 months respectively. The incidence of relapse among the responders was 44% and the overall survival rate was 23%. Only four (31%) patients completed the six cycles of alemtuzumab-hyperCVAD. Others were stopped earlier due to progressive disease (n = 2), cytomegalovirus (CMV) reactivation and/or disease (n = 3), death not due to disease (n = 2), and patient's refusal to continue alemtuzumab (n = 2). The incidence of death not due to disease, CMV reactivation and recurrent CMV reactivation were 50, 50 and 17%, respectively. This study shows that alemtuzumab in combination with hyperCVAD regimen is a feasible regimen but with high toxicity. The toxicity might be reduced with the incorporation of filgrastim and use of valganciclovir as CMV prophylaxis.

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Post‐transplant hepatosplenic T‐cell lymphoma successfully treated with hyperCVAD regimen

Cited by 28 publications

References 21 publications

The aggressive peripheral T‐cell lymphomas: 2015

The aggressive peripheral T‐cell lymphomas: 2015

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

The Outcome of HyperCVAD Combined with Alemtuzumab for the Treatment of Aggressive T-Cell and NK-Cell Neoplasms

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