Rituximab in combination with CHOP regimen in T-cell angioimmunoblastic lymphoma (AILD-TL) rich in large B cells. Favourable results in four patients

Joly, B.; Frenkel, V.; Belhadj, K.; Gnaoui, T. El; Rahmouni, A.; Gaulard, Philippe; Delfau-Larue, M. H.; Reyes, F.; Haioun, C.

doi:10.1200/jco.2004.22.90140.6694

Cited by 6 publications

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“…The use of rituximab in AITL is rather controversial. Although preliminary studies suggested a potential benefit [14,15], a recent multicenter phase II study including 25 patients with AITL treated with R-CHOP did not confirm these findings [16]. However, only six patients (24%) in that study had a CD20-positive background, as our case did.…”

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confidence: 79%

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

et al. 2011

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A 41-year-old Caucasian man with a medical history of hypertension and an Eastern Cooperative Oncology Group performance status of 0 presented with abdominal pain, fatigue, and 10-pound weight loss for 2 months. He denied fevers or night sweats. On physical exam, the patient had bilateral inguinal lymphadenopathy up to 2 cm in diameter. Computed tomography (CT) scans revealed lymphadenopathy above and below the diaphragm and mild splenomegaly. Hemoglobin level was 13 g dL 21 (normal range: 13.5-16.0 g dL 21 ). The patient underwent an excisional biopsy of a left cervical lymph node and was discharged in stable condition.At this time, the differential diagnosis in this mildly anemic young man with weight loss and lymphadenopathy is very broad but includes infections and autoimmune processes. Oncologic conditions, such as lymphomas, should also be evaluated.He represented 1 week later with severe fatigue and hypotension. The patient had a hemoglobin of 5.5 g dL 21 , white blood cell count of 23.7 3 10 9 L 21 (normal range: 3.5-11.0 3 10 9 L 21), and platelet count of 123 3 10 9 L 21 (normal range: 150-400 3 10 9 L 21). The differential showed 55% neutrophils, 6% bands, 20% lymphocytes, 11% monocytes, 4% eosinophils, and 2% metamyelocytes. Patient denied hemoptysis, melena, or bright red blood per rectum. Two units of packed red blood cells (RBCs) were transfused with minimal increase in his hemoglobin levels.The hemoglobin level went from 13 to 5.5 g dL 21 in 1 week; this is an acute process. The differential includes acute bleeding or hemolysis. His blood counts also show leukocytosis and thrombocytopenia. Given the lack of response to transfusions, this could be an immune-mediated hemolytic phenomenon either primary or associated with an infectious process, such as acute EBV or Mycoplasma infection. The patient should also be worked up for gastrointestinal bleeding, although it is less likely the cause of such a marked decrease in his hemoglobin without evidence of frank hematochezia or melena.Additonal workup showed an elevated lactate dehydrogenase (LDH) level (663 IU L 21 ), reticulocytosis (8.2%), and undetectable haptoglobin (<5.8 mg dL 21 ). A peripheral blood smear did not show schistocytosis or spherocytosis but revealed circulating myelocytes, metamyelocytes, nucleated RBCs, and RBC agglutination. Fecal occult blood test was negative.This presentation is consistent with an acute acquired hemolytic process. The age of the patient makes congenital causes of hemolysis unlikely. The differential diagnosis includes autoimmune or drug-induced hemolysis and cryoglobulinemia. The presence of RBC agglutination supports the possibility of cryoglobulinemia. The lack of schistocytes does not support a microangiopathic process such as thrombotic thrombocytopenic purpura or disseminated intravascular coagulation. The concurrent presence of myeloid and erythroid precursors suggests a myelophthisic anemia, which could be associated with intramedullary hemolysis.Direct Coombs test was positive for immunoglobulin G (IgG)...

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confidence: 79%

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

et al. 2011

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“…The presence of EBV-infected B-cells in the tumor has led to clinical trials of rituximab. One report from France was initially positive [60], but a longer follow-up and more patients did not find a benefit of adding rituximab to a chemotherapy regimen [61]. Twelve patients were reported who received single agent cyclosporine as salvage therapy (i.e., 10 patients) or as initial treatment in two unwell/elderly patients [62].…”

Section: Angioimmunoblastic T-cell Lymphomamentioning

confidence: 99%

The aggressive peripheral T‐cell lymphomas: 2015

Armitage

2015

American J Hematol

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Background: T‐cell lymphomas make up approximately 10%–15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia.Diagnosis: The diagnosis of aggressive peripheral T‐cell lymphoma (PTCL) is usually made using the World Health Organization classification. The ability of hematopathologists to reproducibly diagnosis aggressive PTCL is lower than that for aggressive B‐cell lymphomas, with a range of 72%–97% for the aggressive PTCLs.Risk Stratification: Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, positron emission tomography scans seem to be useful as they are in aggressive B‐cell lymphomas. The most commonly used prognostic index is the International Prognostic Index. The specific subtype of aggressive PTCL is an important risk factor, with the best survival seen in anaplastic large‐cell lymphoma—particularly young patients with the anaplastic lymphoma kinase positive subtype.Risk‐Adapted Therapy: Anaplastic large‐cell lymphoma is the only subgroup to have a good response to a CHOP‐like regimen. Angioimmunoblastic T‐cell lymphoma has a prolonged disease‐free survival in only ∼20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL‐not otherwise specified is not one disease. Anthracycline‐containing regimens have disappointing results, and a new approach is needed. Natural killer/T‐cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy‐containing regimens. Enteropathy‐associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy, although selected patients with enteropathy‐associated PTCL seem to benefit from intensive therapy. Am. J. Hematol. 90:666–673, 2015. © 2015 Wiley Periodicals, Inc.

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“…Other immune-modulating and antiangiogenic agents, including bevacizumab, 87 rituximab, 102 lenalidomide, and thalidomide, are also being explored as single agents and in combination with chemotherapy. A phase 2 study of lenalidomide at a dose of 25 mg/m 2 daily for 21 days of a 28-day cycle was conducted in 24 relapsed PTCL patients.…”

Section: Immunomodulators and Immunosuppressantsmentioning

confidence: 99%

Peripheral T-cell lymphoma

Foss

Zinzani

Vose

et al. 2011

Blood

280

226

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Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of clinically aggressive diseases associated with poor outcome. Studies that focus specifically on PTCL are emerging, with the ultimate goal of improved understanding of disease biology and the development of more effective therapies. However, one of the difficulties in classifying and studying treatment options in clinical trials is the rarity of these subtypes. Various groups have developed lymphoma classifications over the years, including the World Health Organization, which updated its classification in 2008. This article briefly reviews the major lymphoma classification schema, highlights contributions made by the collaborative International PTCL Project, discusses prognostic issues and gene expression profiling, and outlines therapeutic approaches to PTCL. These include the standard chemotherapeutic regimens and other modalities incorporating antifolates, conjugates, histone deacetylase inhibitors, monoclonal antibodies, nucleoside analogs, proteasome inhibitors, and signaling inhibitors. As this review emphasizes, the problem has now evolved into an abundance of drugs and too few patients available to test them. Collaborative groups will aid in future efforts to find the best treatment strategies to improve the outcome for patients with PTCL. (Blood. 2011;117(25): 6756-6767)

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Rituximab in combination with CHOP regimen in T-cell angioimmunoblastic lymphoma (AILD-TL) rich in large B cells. Favourable results in four patients

Cited by 6 publications

References 0 publications

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis

The aggressive peripheral T‐cell lymphomas: 2015

Peripheral T-cell lymphoma

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