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Long-term remission after high-dose chemotherapy followed by auto-SCT as consolidation for intravascular large B-cell lymphoma

Bone Marrow Transplantation volume 49, pages 1543–1544 (2014)Cite this article

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Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL) with variable manifestations in patients. Accordingly, it is difficult to determine a definite diagnosis in many cases. However, the recent recognition of IVLBCL has led to rapid and definite diagnoses.1 In addition, the clinical outcomes of patients with IVLBCL have improved in the rituximab era, with a reported CR rate of 82% and a 2-year PFS rate of 56%.2, 3, 4 High-dose chemotherapy (HDC) followed by autologous PBSC transplantation (auto-PBSCT) might be an efficient treatment; however, there are insufficient data to support the efficacy of HDC/auto-PBSCT against IVLBCL.2,5,6 A recent report demonstrated that up-front HDC/auto-PBSCT improved the 2-year PFS to 69% in patients with international prognostic index (IPI) high/intermediate or high-risk DLBCL and responses to induction therapy, in comparison to the 2-year PFS of 55% in patients with induction therapy alone.7 As most patients with IVLBCL were classified into the IPI high-risk group, the up-front HDC/auto-PBSCT during the first CR may represent a useful treatment option for patients with IVLBCL.

In Japan, the use of rituximab for DLBCL was approved in September 2003. Sixteen patients with IVLBCL were diagnosed in the Fukuoka Bone Marrow Transplantation Group (FBMTG) that began in 2004. Among the 16 patients, 9 were ineligible for HDC/auto-PBSCT because they were too old (over 70 years), and one 63-year-old man was ineligible for HDC because of the lung damage that occurred during the first course of chemotherapy. Subsequently, we retrospectively analyzed six patients with IVLBCL who underwent HDC/auto-PBSCT as a consolidation therapy in FBMTG (Table 1). The present study was approved by the institutional ethics committee of Kyushu University Graduate School of Medical Sciences. The median age at diagnosis was 61.5 years (range: 43–68 years). All six patients had stage IV disease at diagnosis, and three developed hemophagocytic syndrome (HPS). According to IPI, five patients were categorized as high risk and one as high/intermediate risk at diagnosis. Six cycles of R-CHOP regimen (rituximab, CY, VCR, doxorubicin and prednisolone) were administered as the initial treatment to four patients, and six cycles of R-THP-COP regimen (rituximab, pirarubicin, CY, VCR and prednisolone) were administered to two elderly patients. Auto-PBSCs were collected during hematological recovery after high-dose etoposide (500 mg/m2 for 3 days) with or without rituximab. The median time from diagnosis to auto-PBSCT was 7.0 months (range: 5.6–7.4 months). All patients had achieved CR status without radiographic and laboratory abnormalities (including IVLBCL and HPS in the BM) at HDC/auto-PBSCT. The conditioning regimen in four patients was referred to as R-MCEC, which consisted of rituximab, ranimustine, carboplatin, etoposide and CY. Two elderly patients were treated with high-dose cytarabine-based regimens that excluded cardiotoxic high-dose CY. The median number of infused CD34-positive cells was 6.1 × 106 cells/kg (range: 1.7–30.0 × 106 cells/kg). The median time for neutrophil recovery over 0.5 × 109/L was 10 days (range: 7–12) and for platelets over 20 × 109/L was 15 days (range: 9–21). No patient died of toxic adverse events, and all patients maintained CR status. One patient developed CY-related heart failure but improved with supportive care. Four patients who received R-MCEC developed late-onset neutropenia (LON) without severe infections at a median of 89 days after auto-PBSCT (range: 68–121 days). One patient developed secondary myelodysplastic syndrome with refractory anemia at day 242 after auto-PBSCT and was observed without treatment.

Table 1 Patients’ characteristics and results
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Acknowledgements

We would like to thank the physicians, nurses, pharmacists, and data managers in FBMTG involved in our patient care. This work was supported in part by MEXT KAKENHI (Grant Number 25461453) to KK.

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Authors and Affiliations

  1. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, Fukuoka, Japan

    K Kato, F Jinnouchi, K Kohno, T Kuriyama, T Miyamoto & K Akashi

  2. Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Y Ohno, H Kusumoto & T Tochigi

  3. Department of Hematology, Harasanshin Hospital, Fukuoka, Japan

    T Kamimura

  4. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    H Henzan, K Takase, I Kawano, M Kadowaki, R Nawata, T Muta & T Eto

  5. Center for Cellular and Molecular Medicine, Kyushu University Graduate School of Medical Science, Fukuoka, Japan

    H Iawasaki & K Akashi

  6. Department of Pathology, School of Medicine, Kurume University, Kurume, Japan

    K Ohshima

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  1. K Kato
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Correspondence to K Kato.

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Kato, K., Ohno, Y., Kamimura, T. et al. Long-term remission after high-dose chemotherapy followed by auto-SCT as consolidation for intravascular large B-cell lymphoma. Bone Marrow Transplant 49, 1543–1544 (2014). https://doi.org/10.1038/bmt.2014.189

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