Successful Autologous Bone Marrow Transplantation in Intravascular Lymphomatosis

Rosé, Christian; Staumont, D.; Jouet, Jean Pierre

doi:10.1046/j.1365-2141.1999.1368a.x

Cited by 9 publications

(14 citation statements)

References 4 publications

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“…Rose et al 5 reported the case of a patient with IML who was treated with autologous bone marrow transplantation. They recommended use of marrow as the source of rescue rather than CD34-positive cells because of the inability of the lymphoma cells to extravasate and the peculiar localization of this strange lymphoma.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Koizumi

Nishimura

Yokota

et al. 2001

Bone Marrow Transplant

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Summary:Intravascular malignant lymphocytosis (IML) is a rare systemic disease characterized by proliferation of malignant B (rarely T) lymphoid cells within the lumina of small arteries, veins, and capillaries. Diagnosis requires skin, liver, renal, meningeal, or brain biopsy, but is rarely made ante mortem. In this report, we describe a patient who had an ante mortem diagnosis of IML as a result of a skin biopsy. Autologous peripheral blood stem cell transplantation (auto-PBSCT) was successfully performed after chemotherapy. The patient has survived for more than 30 months since the onset of the disease and maintains complete remission on the 450th day post PBSCT. To our knowledge, this is the first case of IML treated by auto-PBSCT. Bone Marrow Transplantation (2001) 27, 1101-1103. Keywords: intravascular malignant lymphocytosis (IML); skin biopsy; CHOP; auto-PBSCT Case reportA 52-year-old man presented to our hospital in September 1998 with a 9-month history of progressive dementia, hemiparesia, urinary retention, and weight loss. Hasegwa dementia scale (HDS), that is the scale to evaluate the degree of dementia, was 12 point. He had reddish indurated macules scattered over the anterior chest surface. Routine hematological, biochemical and serological values were all within normal limits. Examination of bone marrow showed no abnormal cells. Magnetic resonance imaging (MRI) of the brain demonstrated an increased periventricular signal on T2-weighted images. Computed tomography (CT) scans of the brain disclosed low density areas in the corresponding section. Positron emission tomography of the brain showed degraded blood flow in the left temporal and frontal lobe and right cerebellum. Results of bone marrow biopsy, cerebrospinal fluid examination, CT scans of chest and abdomen, abdominal ultrasound sonography and whole body gallium scintigram were normal. A skin biopsy specimen of the anterior chest eruption revealed atypical hyperchromatic large lymphoid cells within the lumena of capillary vessels. These cells also infiltrated the extravascular spaces. Immunohistochemical study showed that these cells were positive for a B cell marker L26 (CD20), but not for a T cell marker MT-l (CD43) nor endothelial cell marker (CD34). DNA obtained from these cells and bone marrow cells at the time of lymphoma diagnosis showed no immunoglobulin gene rearrangements by reverse transcription polymerase chain reaction (RT-PCR). In addition, the serum soluble interleukin 2 receptor (s-IL2R) value was elevated to 1610 U/ml. Based on the results stated above a diagnosis of IML (B cell type) was established.The clinical course is shown in Figure 1. The patient was treated with a standard regimen comprising doxorubicin, cyclophosphamide, vincristine and prednisone (CHOP). Amnesia, hallucinations, dementia and skin macules regressed after one cycle and the patient achieved a complete response after three cycles, although urinary incontinence and hemiparesis remained. Positron emission tomography of the brain showed normal blood flow...

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Section: Discussionmentioning

confidence: 99%

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Koizumi

Nishimura

Yokota

et al. 2001

Bone Marrow Transplant

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“…[12][13][14][15][16][17][18] On the other hand, a few recent studies suggested that carrier patients may have exacerbated toxicity when treated with antifolate drugs [19][20][21] or reduced survival, possibly through interference with the action of methotrexate. 22,23 Such a dualism has also been reported for additional folate metabolizing gene polymorphisms. 14,[23][24][25] Overall, relationships between clinical outcome and folate pathway gene variants in lymphomas have been poorly investigated.…”

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confidence: 90%

Methylenetetrahydrofolate reductase C677T and A1298C gene variants in adult non-Hodgkin's lymphoma patients: association with toxicity and survival

et al. 2007

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Background and ObjectivesCommon methylenetetrahydrofolate reductase gene variants (MTHFR C677T and A1298C) have been described to have opposite effects on cancer patients. They may reduce cancer susceptibility and increase drug-related toxicity when folate antagonists (e.g. methotrexate) are utilized. We analyzed 110 patients with high-grade non-Hodgkin's lymphoma (NHL), 68 of whom were eligible for a chemotherapy combination containing methotrexate (MACOP-B) and 42 for chemotherapy without methotrexate (CHOP). Design and MethodsPatients were genotyped by polymerase chain reaction and stratified by MTHFR variants. These data were related to the toxicity (WHO grade GO-4) that the patients suffered and their survival. Overall 64 cases (58.2%) developed some form of toxicity and 23 (20.9%) had grade 3/4 toxicity. ResultsWhen considering toxicity of any grade (grade 1-4), the 677TT genotype was significantly over-represented among cases with mucositis (OR=4.85; 95%CI, 1. 47-15.97; p=0.009) and those with hepatic toxicity (OR=3.43; 95%CI, p=0.052). Sub-analyses in the group treated with MACOP-B showed a slight increase in the risk of developing mucositis (OR=5.22; 95%CI, p=0.03), and a strong increase in the risk of hepatic toxicity (OR=7.08; 95%CI, 1.38-36.2; p=0.019) and thrombocytopenia (OR=7.69, 95%CI 1. 0-58.94; p=0.05). Interestingly, compared to the risk of developing toxicity of any grade, the risk of developing severe (grade 3/4) mucositis was almost doubled in the whole group of cases with 677TT (OR=8.13; p=0.011) and dramatically increased in the MACOP-B-treated cases with this gene variant (OR=24.6; 95%CI 2. 49-87.41; p=0.001). There were significant results for 1298CC cases exclusively for mucositis (any grade, OR=5.33; 95%CI, p=0.023 and OR=9.15; 95%CI, p=0.037; for the whole group and the MACOP-B-treated group, respectively). Similarly, the risk of 1298CC patients developing severe mucositis increased (OR=9.24; 95%CI, 1. p=0.017 and OR=11.53; p=0.057; in the whole group and in the MACOP-B-treated group, respectively). Event-free survival analysis revealed a lower probability of event-free survival at 5 years for 677T-carriers (log-ranks, p=0.05 and p=0.07 in the whole group and in the MACOP-B-treated group, respectively). More significant results were obtained when 1298CC cases were excluded from the reference group (log-ranks, p=0.03 and p=0.04, respectively). No significant associations were found in the CHOPtreated group. Interpretation and ConclusionsOur data suggest that MTHFR gene variants play a critical role in NHL outcome, possibly by interfering with the action of methotrexate with significant effects on toxicity and survival. Genotyping of folate pathway gene variants might be useful to enable reduction of chemotherapy toxicity and/or to improve survival by indicating when dose adjustments or alternative treatments are necessary.Key words: non-Hodgkin's lymphoma, MTHFR SNP , toxicity, survival, pharmacogenetics. converts methylenetetrahydrofolate to methyltetrahydrofolate, the major ci...

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“…Interestingly, two cases report sustained remissions after monotherapy with rituximab [43,44]. There are now seven case reports of long-term survival after autologous hematopoietic stem cell transplantation: three patients in first CR (one with CNS involvement) [40,45]; four in second CR [46][47][48][49]; and two patients in whom bone marrow transplant in second CR was unsuccessful [40].…”

Section: Therapymentioning

confidence: 99%

Intravascular Lymphoma: The Oncologist's “Great Imitator”

2006

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Successful Autologous Bone Marrow Transplantation in Intravascular Lymphomatosis

Cited by 9 publications

References 4 publications

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Methylenetetrahydrofolate reductase C677T and A1298C gene variants in adult non-Hodgkin's lymphoma patients: association with toxicity and survival

Intravascular Lymphoma: The Oncologist's “Great Imitator”

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