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abstract nr.: 1429
CNS relapse of Burkitt-like lymphoma successfully treated with initial chemotherapy-CODOX-M/IVAC. A case report
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Author:
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L.P.S. Poplawska-Szczyglowska, Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland |
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Co-author(s):
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B.B. Barbara Brzeska, Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
J.W. Jan Walewski, Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland
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Topic:
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18B: Non Hodgkin's Lymphoma |
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Keywords:
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Burkitt-like lymphoma, CNS relapse |
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Background: Burkitt's (BL) and Burkitt-like (BLL) lymphomas are highly aggresive diseases not curable with conventional standard-dose chemotherapy. Overall and failure-free survival has improved in BL/BLL almost 3-fold at our institution since sub-myeloablative protocol CODOX-M/IVAC (I. Magrath et al, JCO 1996;14:925) was adopted in 1996. However, patients who either do not achieve complete remission (CR) or relapse after treatment almost uniformly die from this lymphoma. Aims: We present an exceptonal case of BLL with primary CNS involvement and early CNS relapse succesfully treated with the same regimen supplemented by additional intathecal (ith) mediacation and radiotherapy (RT). Methods: 47-year old male patient with peripheral, mediastinal and abdominal lymphadenopathy, splenomegaly (CT scans) and peripheral right facial nerve palsy. Histopathology of peripheral lymph node was consistent with BLL (MIB1+++). CSF cytosis was 5/mcl and protein concentation- normal . Cytology and flow cytometry of CSF were both unconclusive for lymphoma. However, MRI showed abnormal signal around right petrous pyramid apex. The patient was diagnosed with BLL, stage IVB (weight loss) and scheduled for high-risk protocol consisting of 2 cycles of CODOX-M (dose of methotrexate [M]- 6,7 g/m2) alternating with 2 cycles of IVAC (dose of cytarabine [A]-8 g/m2). Results: The patient received 4 cycles of intensive chemotherapy incuding 8 doses of ith A and 4 doses of ith M. High-dose M was omitted in the second CODOX-M cycle due to temporary deterioration of creatinine clearance. He experienced grade 4 hematologic toxicity and grade 3 pneumonia. He achieved partial remission (PR) with remaining residual cervical adenopathy. Neurologic symptoms and signs resolved. After 3 months off therapy he returned with right cranial nerve VI and VII palsy, abnormal CSF cytosis and protein, left supraclavicular and right axillar adenopathy. He was given 1 cycle of CODOX-M followed by cranial RT of 30 Gy in 15 fractons, and finally, 1 cycle of IVAC. Intrathecal M and A were given twice a week, except when throbocytopenic. As per 14 months from the end of second treatment he is free of symptoms with persistent minimal peripheral adenopathy. Conclussions: This case of primary CNS BLL is unusual in hahing achieved a durable second very good partial remission and comlete resolution of secondary CNS disease. A possible cause of CNS relapse could be 50% reduction of high-dose M due to renal dysfunction. Successful retreatment supplemented by cranial RT validates high potency of CODOX-M/IVAC in poor risk Burkitt-like lymphoma.
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