Complete Remission of a Diffuse Large B-Cell Lymphoma in a Young Patient, with Severe Tuberous Sclerosis, Treated with Metronomic Chemotherapy and Ibrutinib: A Case Report

Abstract

TTuberous sclerosis (TS) is a rare autosomal dominant genetic multisystem disease caused by mutations in either the TSC1 or TSC2 gene and results in the growth of non-cancerous masses in several organs. Diffuse large B-cell lymphoma (DLBCL) is the predominant non-Hodgkin lymphoma in adolescents and young adults. Metronomic chemotherapy (mCHEMO) ca be defined as the frequent, regular administration of drug doses able to maintain a low, but active, range of concentrations of chemotherapeutic drugs, during prolonged periods of time. We present the case of a young woman with severe TS, who developed DLBCL. She was treated consecutively with the mCHEMO schedule R-DEVEC (prednisone, vinorelbine, etoposide, cyclophosphamide plus rituximab) and then ibrutinib, achieving an impressive long-lasting complete remission. In conclusion, alternative treatments could be necessary when comorbidities are present in patients and mCHEMO can be a potential successful therapeutic approach in frail subjects.

Efficacy and Safety of Metronomic Capecitabine in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…It was concluded from the study that MCT is a good alternative treatment option especially in patients with poor liver function 28 . A complete remission of a diffuse large B-cell lymphoma was observed in a young patient when treated with metronomic chemotherapy involving combination of drugs of prednisone, vinorelbine, etoposide, cyclophosphamide, plus rituximab and finally ibrutinib 29 .…”

Metronomic Chemotherapy in Elderly Patients

“…Although MCT has a good efficacy and it could be used in cancer therapy to overcome the limitations and disadvantages of conventional chemotherapy, the MCT is not completely free from adverse drug reactions (ADR). Highgrade toxic effects are infrequent but low-grade fatigue, mild nausea and vomiting, mild to moderate anemia, neutropenia, leukopenia, and lymphopenia, as well as drug-related toxic events, have been documented [15,22].…”