Lisa Downs

Prognostic value of FDG-PET scan imaging in lymphoma patients undergoing autologous stem cell transplantation

We conducted a retrospective analysis of 50 lymphoma patients (Hodgkins disease and non-Hodgkins lymphoma) who had an 18F-fluoro-deoxyglucose positron emission tomography (FDG-PET) scan after at least two cycles of salvage chemotherapy and before autologous stem cell transplantation (ASCT) at our institution. The patients were categorized into FDG-PET negative (N=32) and positive (N=18) groups. The median follow-up after ASCT was 19 months (range: 3–59). In the FDG-PET-negative group, the median progression-free survival (PFS) was 19 months (range: 2–59) with 15 (54%) patients without progression at 12 months after ASCT. The median overall survival (OS) for this group was not reached. In the FDG-PET-positive group, the median PFS was 5 months (range: 1–19) with only one (7%) patient without progression at 12 months after ASCT. The median OS was 19 months (range: 1–34). In the FDG-PET-negative group, chemotherapy-resistant patients by CT-based criteria had a comparable outcome to those with chemotherapy-sensitive disease. A positive FDG-PET scan after salvage chemotherapy and prior ASCT indicates an extremely poor chance of durable response after ASCT.

Regression of advanced non-splenic marginal zone lymphoma after treatment of hepatitis C virus infection.

We describe a patient with chronic hepatitis C virus (HCV) infection who presented with extranodal (right salivary gland and bone marrow) marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). Within a year, the lymphoma progressed to involve peripheral lymph nodes and the liver. After treatment of HCV with peginterferon and ribavirin, he achieved complete radiographic response and remains in remission two years later. This is an example of a patient in whom treatment of HCV infection led to regression of non-splenic, extranodal marginal zone lymphoma. It suggests that HCV testing and treatment should be considered in all patients with marginal zone lymphomas, including non-splenic types.

Long-term event-free survivors after high-dose therapy and autologous stem-cell transplantation for low-grade follicular lymphoma

Summary:Although follicular lymphoma (FL) is generally responsive to conventional-dose chemotherapy, improved survival in patients with this disease has been difficult to demonstrate. High-dose chemo/radiotherapy followed by autologous stem-cell transplantation (ASCT) can improve response rates, although its effects on survival remain controversial. Between 1990 and 2003, we transplanted 49 patients with low-grade FL at our institution. Twenty-two patients (45%) had undergone histologic transformation at the time of ASCT. In all, 44 patients (90%) had relapsed disease and five patients (10%) were resistant to chemotherapy at the time of transplantation. After ASCT, 30 patients (61%) were in complete remission (CR). The median overall survival (OS) has not been reached, while the median event-free survival (EFS) is 2.4 years. At a median follow-up of 5.5 years (longest 12.4 years), a plateau has been reached with 56% of patients remaining alive, and 35% event-free. ASCT was well tolerated except for two (4%) treatment-related deaths. In multivariable analysis, CR after ASCT and age less than 60 years are the best predictors of EFS and OS. ASCT is thus a safe therapeutic approach in FL, resulting in long-term EFS and OS for some patients, even with transformed disease.

Regression of pulmonary MALT lymphoma after treatment with rituximab

We describe a patient with extranodal (pulmonary) marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) who was refractory to treatment with cytotoxic chemotherapy. After a single four-week course of rituximab she had significant regression of pulmonary lesions and remains progression free 19 months after finishing her treatment. This case report demonstrates the potential efficacy of rituximab as a single therapeutic agent in patients with pulmonary MALT lymphoma.

Primary cardiac lymphoma: Utility of multimodality imaging in diagnosis and management

Primary cardiac lymphoma (PCL) is an extremely rare disease defined as a lymphoma strictly confined to the heart or pericardium without dissemination. We present the case of an 82 yr old male with newly diagnosed PCL and two years of subsequent follow up. This report highlights the utility of a multimodality imaging approach in the diagnosis and management of PCL.

Use of iodine 131I-tositumomab radioimmunotherapy in a patient with Waldenstrom's macroglobulinemia.

Waldenstroms macroglobulinemia is an indolent B-cell malignancy that is characterized by high levels of IgM paraprotein production and is incurable with standard chemotherapy. Iodine 131I-Tositumomab (iodine-131-labeled murine anti-CD20 monoclonal antibody; Bexxar) is a novel radioimmunotherapeutic agent that has a high response rate in relapsed or chemotherapy refractory, CD20-positive, low grade or transformed B-cell non-Hodgkins lymphomas. There are no data on the use of radioimmunotherapy in Waldenstroms macroglobulinemia. We report a patient with Waldenstroms macroglobulinemia with transformation to a large B-cell lymphoma, who was treated successfully with iodine 131I-tositumomab. The patient had a complete response to the treatment, including disappearance of any detectable IgM paraprotein. This case report demonstrates the potential for radioimmunotherapy in CD20 positive B-cell malignancies.

Successful treatment of relapsed lymphomatoid granulomatosis with bexarotene

Lymphomatoid granulomatosis is a rare lymphoproliferative disorder involving the lungs, skin, and other organs. Advanced-stage disease does not tend to respond well to cytotoxic chemotherapy and is associated with a poor prognosis. We present a case of successful treatment of relapsed lymphomatoid granulomatosis with bexarotene, a novel retinoid agent

Marginal zone lymphoma involving subcutaneous fat: appearance by FDG-PET/CT, MRI, and contrast-enhanced CT imaging.

Although marginal zone lymphomas are relatively common, comprising 5% to 8% of all lymphomas, extranodal involvement of the subcutaneous fat is unusual. We report the F-18-2fluoro-2-D-deoxyglucose-positron emission tomography/computed tomography, magnetic resonance imaging, and contrast-enhanced computed tomography appearance of extranodal marginal zone lymphoma involving the subcutaneous fat in a 49-year-old woman with a history of previously treated gastric marginal zone lymphoma.