Successful treatment of relapse of an intravascular B-cell lymphoma with rituximab-CHOP polychemotherapy

Takács, István; Erős, Nóra; Bene, I.; Bozso, F.; Tordai, László; Károlyi, Zsuzsánna; Radványi, Gáspár; Matolcsy, András

doi:10.1007/s00277-004-0897-0

Cited by 17 publications

(13 citation statements)

References 8 publications

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“…However, treatment outcomes for IVLBCL may improve as rituximab-containing chemotherapy is increasingly applied in this disease. Using a regimen with rituximab that was previously developed for DLBCL, several investigators observed an improvement in the outcome for IVLBCL [29,30,31]. Two retrospective analyses from Europe and Japan reported significantly better outcomes for IVLBCL with rituximab-containing chemotherapy compared to chemotherapy without rituximab [7,8].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Hong

Kim²,

Ko³

et al. 2013

Acta Haematol

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Background: Clinical features and treatment outcomes of intravascular large B-cell lymphoma (IVLBCL) have rarely been reviewed due to its rarity and pathologic obscurity. Methods: We analyzed 20 patients who were pathologically diagnosed with IVLBCL at the Samsung Medical Center. Results: Initial manifestations were nonspecific, such as fever with cytopenia, elevated serum lactate dehydrogenase and hypoalbuminemia. Hemophagocytosis was frequent and bone marrow was the most common site of pathologic diagnosis in our series. Hepatosplenomegaly, pleural effusion and ground-glass opacity in the lungs were also commonly found, and positron emission tomography imaging showed increased ¹⁸F-fluorodeoxyglucose uptake in the involved organs. All patients received CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or rituximab-CHOP. The median overall survival (OS) was 38.9 months (95% confidence interval 6.7-71.1). Rituximab-containing chemotherapy compared to chemotherapy alone resulted in higher 3-year OS (71.4 and 25.0%; p = 0.027). Patients with hemophagocytosis had a poorer 3-year OS compared to patients without hemophagocytosis (29.6 and 75%; p = 0.046). Prognostic factor analysis showed the association of pleural effusion with worse OS (p = 0.002). Conclusions: Treatment with rituximab-containing chemotherapy can improve the treatment outcome of IVLBCL. Pleural effusion may be a poor prognostic factor in patients with IVLBCL.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Hong

Kim²,

Ko³

et al. 2013

Acta Haematol

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“…Our experience is consistent with the studies maintaining that patients with IVL who receive systemic anthracycline-based chemotherapy may achieve complete remission. The addition of rituximab to anthracycline-based chemotherapy has been evaluated in three case reports exclusively of the cutaneous variant of IVL [16][17][18]. Sustainable remission has also been described in a case report of single-agent rituximab in disseminated IVL [19].…”

Section: Discussionmentioning

confidence: 99%

Disseminated Intravascular B-Cell Lymphoma: Clinicopathological Features and Outcome of Three Cases Treated with Anthracycline-Based Immunochemotherapy

Bouzani¹,

Karmiris²,

Rontogianni

et al. 2006

The Oncologist

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The purpose of this study was to evaluate the use of combination anthracycline-based immunochemotherapy in intravascular lymphoma (IVL). This is an extremely rare, disseminated, and aggressive extranodal CD20 + non-Hodgkin's lymphoma (NHL) with poor outcome following anthracycline-based chemotherapy. From a population of 700 newly diagnosed patients with NHL who were registered and followed up at our unit between 1990 and 2005, three cases (0.4%) have been classified as IVL. Among the patients, there were two men and one woman, with a median age of 52 years. We have assessed the clinicopathological characteristics, response to therapy, and outcome. All patients presented with systemic symptoms and disseminated disease. All patients received anthracycline-based chemotherapy in combination with the anti-CD20 monoclonal antibody rituximab (immunochemotherapy). Complete remission was achieved in all three patients, and currently all remain progression free with a follow-up of 24-45 months. In conclusion, anthracycline-based immunochemotherapy induces durable remissions in patients with IVL, an ultimately fatal disease, suggesting that the clinical course of this disease may be altered with immunochemotherapy. The Oncologist 2006;11:923-928

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“…Although highdose chemotherapy with autologous peripheral blood stem cell transplantation might be a promising strategy, very few IVL patients are likely to benefit, since most of these patients are elderly and in poor PS. Several authors have recently described the effectiveness of rituximab combined with the CHOP regimen for patients with IVL [5,6], and Bazhenova et al [7] described a patient with IVL whose CR persisted for 3 years without relapse after treatment with rituximab alone. The response of our patient to rituximab was extremely positive, with a long-term CR, which was also maintained on rituximab alone.…”

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confidence: 98%

Chemotherapy-resistant intravascular lymphoma accompanied by ADAMTS13 inhibitor successfully treated with rituximab

et al. 2008

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Intravascular large B-cell lymphoma (IVL) is a subtype of diffuse large B-cell lymphoma (DLBCL), in which lymphoma cells infiltrate blood vessels without mass formation, and its prognosis is generally poor due to diagnostic difficulties. The authors previously described a patient with IVL accompanied by features of thrombotic thrombocytopenic purpura (TTP), expression of ADAM-TS13 inhibitor, and a severe deficiency in ADAMTS13 activity [1]. Although standard CHOP chemotherapy was initially effective, the disease gradually became resistant despite intensive high-dose chemotherapy with autologous peripheral blood stem cell support. However, the chimeric anti-CD20 monoclonal antibody, rituximab, induced complete remission (CR) for a prolonged period. We describe the clinical course of this patient and the unique effects of treatment with rituximab alone.A 54-year-old man was admitted to our hospital with the onset of a psychological disorder and convulsions. Laboratory data revealed obvious thrombocytopenia (3.6 9 10 4 / lL) accompanied by elevated levels of serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor. Multiple cerebral venous embolisms, bilateral adrenal gland swelling, and hepatosplenomegaly were present without nodal disease. Despite normal chest X-rays and thoracic CT scans, the patient developed rapidly progressive respiratory failure. A definitive diagnosis of IVL was made from transbronchial lung biopsy (TBLB) specimens. Bone marrow smears revealed no obvious lymphoma cell invasion and megakaryocyte hyperplasia without hemophagocytic syndrome (HPS), although the peripheral blood platelet count was markedly decreased. We concluded that the thrombocytopenia was caused by the same pathogenesis as TTP, since plasma ADAMTS13 activity had decreased to below 3%, and active ADAMTS13 inhibitor (IgG-type autoantibody) was confirmed. After standard CHOP chemotherapy cycles, the platelet counts immediately recovered to within normal limits and all symptoms improved. The ADAMTS13 activity improved to 49% and inhibitor levels, which had never been negative, decreased. Whole brain irradiation after chemotherapy resulted in relapse of systemic disease. Although we performed highdose conditioning chemotherapy followed by autologous peripheral stem cell transplantation, respiratory failure and high-grade fever appeared with severe thrombocytopenia and massive serum LDH elevation at day 50 after transplantation. Salvage combination chemotherapies had extremely limited effects against the disease, and we started to administer 375 mg/m 2 of rituximab after its use for CD20-positive DLBCL was permitted according to the regulations established by the Japanese National Health Insurance system. The patient did not develop any major

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Successful treatment of relapse of an intravascular B-cell lymphoma with rituximab-CHOP polychemotherapy

Cited by 17 publications

References 8 publications

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Disseminated Intravascular B-Cell Lymphoma: Clinicopathological Features and Outcome of Three Cases Treated with Anthracycline-Based Immunochemotherapy

Chemotherapy-resistant intravascular lymphoma accompanied by ADAMTS13 inhibitor successfully treated with rituximab

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