Successful rituximab-CHOP treatment of systemic lupus erythematosus associated with diffuse large B-cell non-Hodgkin lymphoma

Abstract

The authors discuss the case of a 76-year-old female patient who has been suffering from subacute cutaneous lupus erythematosus since 1983. In 1999 she was diagnosed with systemic lupus erythematosus (SLE) based on her symptoms of malar rash, polyarthritis, leukopenia, autoimmune hemolytic anemia and positive anti-DNA antibody test. For this she received methylprednisolone and cyclophosphamide. After 3 years of remission, symptoms of cutaneous vasculitis appeared in 2004, which transitionally responded to treatment with azathioprin and methylprednisolone. Her cutaneous symptoms, however, progressed quickly along with generalized lymphadenopathy, splenomegaly and thrombocytopenia. Immunohistological evaluation of the lymph node biopsy showed diffuse large B-cell lymphoma. She developed complete remission after treatment with six-cycle R-CHOP (rituximab, and reduced doses of cyclophosphamide, vincristin, adriablastin, methylprednisolone). SLE became inactive and her symptoms of vasculitis resolved. The authors are bringing attention to one of the possible late complications of systemic lupus, and also underscoring that treatment with rituximab (+CHOP) was beneficial not only for the lymphoma but the SLE as well.

Molecularly Targeted Therapy: Past, Present and Future

“…Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen on B-lymphocytes. It was licensed for the treatment of non-Hodgkin B-cell lymphomas (NHL) as well as B-cell-induced autoimmune diseases [47,48]. By directly targeting CD20 on B-lymphocytes, rituximab exerts an anti-tumor activity through antibody-dependent cellular cytotoxicity and complement-mediated lysis [47,48].…”

“…It was licensed for the treatment of non-Hodgkin B-cell lymphomas (NHL) as well as B-cell-induced autoimmune diseases [47,48]. By directly targeting CD20 on B-lymphocytes, rituximab exerts an anti-tumor activity through antibody-dependent cellular cytotoxicity and complement-mediated lysis [47,48]. Other protein kinase inhibitors that are in advanced stages of clinical trials include the cyclin-dependent kinase inhibitor flavopiridol (Alvocidib, HMR-1275, Sanofi Aventis Incorporation) for the treatment of chronic lymphocytic leukemia and a variety of solid tumors [49].…”

Lymphoproliferative Disorders in Patients with Systemic Lupus Erythematosus

“…Patients with SLE have an increased risk to develop lymphomas specially diffuse large B cell lymphoma (Löfstrom et al, 2007;Bernatsky et al, 2006: King & Costenbader, 2007Lin et al, 2003;Rossi et al, 2011;Biasiotta et al, 2010;Simon et al, 2007) and marginal zone lymphomas (Maeda et al, 2008;Gonzalez et al, 2009;Tektonidou, 2010) however, several subtypes have been reported.…”

Autoimmune Disorders and Lymphomas

“…The pooled analysis combining these data with those of other large cohort studies provided a SIR estimate for HL in SLE of 3.16. Generally, aggressive lymphomas, such as DLBCL are more common in SLE patients , Simon et al, 2007, Bernatsky et al, 2005a, Lofstrom et al, 2007. In general population, DLBCL accounts for 30% of all lymphomas, but in SLE patients this percentage is between 38% and 64% , Bernatsky et al, 2005a, King & Costenbader, 2007.…”