Primary mediastinal B-cell lymphoma : metabolic and anatomical features in 18FDG-PET/CT and response to therapy

Aim of the study : Determining the role of PET/CT imaging in the evaluation of treatment efficacy in primary mediastinal B-cell lymphoma (PMBCL). Material and methods : Retrospective analysis of seven PMBCL patients, treated at the University Hospital in Krakow, with interim PET/CT after the third course of chemo-immunotherapy. The analysis was based on the calculation of exact tumour volume and metabolic activity, compared with initial values (directly after diagnosis). Results: Patients (five females, two males, average age 26.2 years, range 18–40 years), in clinical stage IIBX at diagnosis, were treated with eight cycles of R-CHOP-14 regimen, with radiotherapy consolidation (7/7) and central nervous system prophylaxis (6/7). The observed decrease in tumour volume between the initial staging and the interim PET ranged 72–89%. The mean ∆SUV max reduction between initial (when available) and interim PET was 87% (range 84–89%). In 3/7 cases in the interim PET/CT, the uptake of the tumour was higher than the liver (Deauville Criteria score 4–5), and in 4/7 it was lower than the liver but higher than mediastinal blood pool structures (score 3 according to Deauville Criteria). After a median follow-up of 58 months – OS and EFS is 100%. Conclusions: The excellent clinical outcome in the study group corresponds with very good metabolic and volumetric response in the interim PET. The ∆SUV max seems to be easier in implementation and has a more significant impact than other measurements

Opóźniona neutropenia po chemioimmunoterapii i radioterapii u chorego z chłoniakiem pierwotnym śródpiersia

We describe a case report of 30-years-old man with a diagnosis of primary mediastinal B-cell lymphoma (PMBCL) who received 8 cycles of chemioimmunotherapy consisting with rituximab and CHOP every 14 days (R-CHOP-14) and subsequent mediastinal irradiation. Two months after the completion of treatment a profound neutropenia was noted which lasted for 2 months. Trephine biopsy of the bone marrow and subpopulation of peripheral blood lymphocytes as well as negative viruses tests suggested immunologic mechanism of rituximab-induced neutropenia. Transient increasing of neutrophil number was observed after granulocyte-specific colony-stimulating factor (G-CSF) treatment but full recovery of neutrophil count was obtained after short course of steroids administration. Two years and 4 months after completion of treatment, the complete remission of the disease and normal peripheral blood counts were confirmed.Przedstawiono opis przypadku dotyczący 30-letniego chorego z rozpoznaniem chłoniaka pierwotnego śródpiersia (PMBCL), którego poddano 8 cyklom chemioimmunoterapii z zastosowaniem rytuksymabu w połączeniu z 14-dniowym schematem CHOP (R-CHOP-14), a następnie radioterapii śródpiersia. Dwa miesiące po zakończonym leczeniu w badaniu morfologii krwi stwierdzono u chorego granulocytopenię, która utrzymywała się przez 2 miesiące. Wyniki badania histopatologicznego szpiku kostnego i subpopulacji limfocytów krwi obwodowej oraz wykluczenie infekcji wirusowych sugerowały immunologiczny mechanizm granulocytopenii indukowanej rytuksymabem. Przejściowy wzrost liczby leukocytów uzyskano po zastosowaniu granulocytarnego czynnika wzrostu (G-CSF), natomiast trwałą normalizację obrazu krwi obwodowej - po krótkotrwałej kortykosteroidoterapii. Dwa lata i 4 miesiące po zakończonym leczeniu u pacjenta stwierdza się całkowitą remisję choroby i prawidłowy obraz krwi obwodowej

Radioimmunotherapy for lymphoma : analysis of clinical trials and treatment algorithms

Ibritumomab, an 90Yttrium (90Y) labelled radioimmunoconjugate, is registered in Europe to treat follicular lymphomas. Its mode of action combines the selectivity of monoclonal antibodies with the efficiency of radiotherapy, making it a unique and useful therapeutic agent. This paper is for haemato-oncologists with a decent practice in lymphoma therapy, who have not yet used ibritumomab themselves. It summarizes clinical trials with radioimmunotherapy, indicating clinical situations where it may be specifically useful

Radioimmunotherapy for lymphoma - analysis of clinical trials and treatment algorithms

Ibritumomab, an 90Yttrium (90Y) labelled radioimmunoconjugate, is registered in Europe to treat follicular lymphomas. Its mode of action combines the selectivity of monoclonal antibodies with the efficiency of radiotherapy, making it a unique and useful therapeutic agent. This paper is for haemato-oncologists with a decent practice in lymphoma therapy, who have not yet used ibritumomab themselves. It summarizes clinical trials with radioimmunotherapy, indicating clinical situations where it may be specifically useful

Skuteczność liposomalnej cytarabiny w leczeniu pierwotnego i wtórnego zajęcia ośrodkowego układu nerwowego w przebiegu chłoniaków nieziarniczych – ocena retrospektywna pacjentów leczonych w Klinice Hematologii UJ CM

Intrathecally-administered liposomal cytarabine (DepoCyte – slow release formula) is an efficient way of treatment in primary and secondary central nervous system (CNS) involvement in patients with non-Hodgkin lymphoma. Thirty-six patients with CNS lymphoma were analyzed. Median age was 48 years (18–73). There were 18 males and 18 females.In patients with lymphoma infiltrations circumscribed to cerebro-spinal fluid, intrathecal liposomal cytarabine alone allowed for 100% responses, with concomitant improvement of performance status (as assessed by Karnofsky score). None of the patients relapsed in CNS within an average observation time of 28 months.Intrathecal liposomal cytarabine combined with whole brain radiotherapy or/and CNS-penetrating chemotherapy allowed to obtain 85.7% cytological responses (90.9% in patients with primary CNS lymphoma): 50% CR and 28.6% PR. Patient's general status improved in 50% of patients.The treatment was well tolerated. Most of the associated adverse events (AE) were mild and moderate (grade 1–2 according to CTCAE); only 5.6% of AE were considered as severe. Headache was the most common complication; whereas cauda equina syndrome was considered as potentially the most dangerous condition. Transient cauda equina syndrome was observed in 1 patient (2.8% of all AEs)