Rituximab Monotherapy for Compressive Optic Neuropathy With Giant Ocular Adnexal Mucosa–Associated Lymphoid Tissue lymphoma

Abstract

A rare case of compressive optic neuropathy due to giant mucosa-associated lymphoid tissue lymphoma in the orbit was presented. A 87-year-old woman was aware of a slow progressive left ocular proptosis for 10 years and presented after becoming aware of a sudden progression of the proptosis accompanying visual disturbance over the previous 2 months. Orbital imaging and a biopsy of the tumor revealed a mucosa-associated lymphoid tissue lymphoma occupying her left orbit compressing and stretching the left optic nerve. Considering her age and the additional adverse effects of external beam radiation therapy to her damaged optic nerve, rituximab monotherapy was utilized. The intervention resulted in almost complete regression without any serious adverse effect, with left eye best–corrected visual acuity improving from 12/200 to 16/20. Rituximab monotherapy can be one of the first-choice treatment options for mucosa-associated lymphoid tissue lymphoma, especially in cases with the critical damage in the optic nerve.

Watchful waiting is an acceptable treatment option for asymptomatic primary ocular adnexal mucosa‐associated lymphoid tissue lymphoma: A retrospective study

“… 11 , 12 Given the excellent visual outcomes following cataract surgery, 32 RT should not be avoided in POAML patients in case of the need for local control. In contrast, although rituximab monotherapy is considered an alternative treatment option for POAML, 17 , 18 , 19 , 20 its efficacy remains unclear. In our study, the ORR and CR in the R group were 73.7% and 42.1%, respectively, which were lower than those in the RT group.…”

“…9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 However, complications, such as cataracts, retinitis, dry eye, and optic neuropathy, of RT occasionally lead to irreversible damage. 12 , 13 , 14 , 15 , 16 Other treatment strategies, such as rituximab monotherapy, 17 , 18 , 19 , 20 immunochemotherapy, 21 intralesional rituximab, 22 and antibiotic therapy for Chlamydia psittaci , 23 have been used for POAML treatment, but their long‐term benefits and the superiority of one strategy over others are unclear. Considering no significant difference in overall survival (OS) between watchful waiting (WW) and rituximab monotherapy or immunochemotherapy in asymptomatic patients with advanced‐stage, low‐grade lymphomas, such as follicular lymphoma, 24 , 25 , 26 WW is expected to be a therapeutic option for POAML, too; however, the benefits of WW for POAML patients are unclear.…”

Watchful waiting is an Acceptable Treatment Option for Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma: A Retrospective Study

“…Given the excellent visual outcomes following cataract surgery [32], RT should not be avoided in POAML patients in case of the need for local control. In contrast, although rituximab monotherapy is considered an alternative treatment option for POAML [18][19][20][21], its e cacy remains unclear. In our study, the ORR and CR in the R group were 73.7% and 42.1%, respectively, which were lower than those in the RT group.…”

“…However, complications, such as cataract, retinitis, dry eye, and optic neuropathy, of RT occasionally lead to irreversible damage [13][14][15][16][17]. Other treatment strategies, such as rituximab monotherapy [18][19][20][21], immunochemotherapy [22], intralesional rituximab [23], and antibiotic therapy for Chlamydia psittaci [24], have been used for POAML treatment, but their long-term bene ts and the superiority of one strategy over others are unclear. Considering no signi cant difference in overall survival (OS) between watchful waiting (WW) and rituximab monotherapy or immunochemotherapy in asymptomatic patients with advanced-stage, low-grade lymphomas, such as follicular lymphoma [25][26][27], WW is expected to be a therapeutic option for POAML, too; however, the bene ts of WW for POAML patients are unclear.…”