Lenalidomide and temozolomide combination in a very elderly patient with CNS relapse of diffuse large b-cell lymphoma.
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Keywords
lymphoma
Abstract
A 83 years old woman with CNS relapse occurred 6 months after chemoimmunoitherapy. The patient was defined ineligible for radiotherapy (RT) and started oral temozolomide 250mg daily for 5 consecutive days without any improvement after 1st cycle.
We administer lenalidomide 25mg daily for 21 days every 28 days together with temozolomide 250mg daily for 5 days every 28 days. The patient experienced a rapid improvement of general and cognitive conditions; Gadolinium-enhnaced brain MRI showed a wide reduction of neoplastic tissue. The patients maintained good clinical conditions with mild treatment toxicity until the end of 6th cycle, when brain MRI showed disease progression and the patient died 1 month later.
We suggest lenalidomide could be a feasible option for CNS relapse in elderly DLBCL patients and it could be associated in future studies with other cytotoxic agents such as temozolomide
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References
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2. Schmitz N, Zeynalova S, Nickelsen M, Kansara R, Villa D, Sehn LH, Glass B, Scott DW, Gascoyne RD, Connors JM, Ziepert M, Pfreundschuh M, Loeffler M, Savage KJ. CNS International Prognostic Index: A Risk Model for CNS Relapse in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP. J Clin Oncol, 2016; 34: 3150-3156 doi: 10.1200/JCO.2015.65.6520 PMID:27382100
3. Cheah CY, Seymour JF. Central nervous system prophylaxis in non-Hodgkin lymphoma: who, what, and when? Curr Oncol Rep, 2015; 17: 25 doi: 10.1007/s11912-015-0450-4. PMID:25912004
4. Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, Walewski J, André M, Johnson PW, Pfreundschuh M, Ladetto M; ESMO Guidelines Committee. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2015; 26: v116-125 DOI:10.1093/annonc/mdv304 PMID:26314773
5. Ferreri AJ, Bruno-Ventre M, Donadoni G, Ponzoni M, Citterio G, Foppoli M, Vignati A, Scarfò L, Sassone M, Govi S, Caligaris-Cappio F. Risk-tailored CNS prophylaxis in a mono-institutional series of 200 patients with diffuse large B-cell lymphoma treated in the rituximab era. Br J Haematol, 2015; 168: 654-662 doi: 10.1111/bjh.13194. PMID:25312994
6. Kurzwelly D, Glas M, Roth P, Weimann E, Lohner H, Waha A, Schabet M, Reifenberger G, Weller M, Herrlinger U. Primary CNS lymphoma in the elderly: temozolomide therapy and MGMT status. J Neurooncol, 2010; 97: 389-392 doi: 10.1007/s11060-009-0032-0. PMID:19841864
7. Witzig TE, Vose JM, Zinzani PL, Reeder CB, Buckstein R, Polikoff JA, Bouabdallah R, Haioun C, Tilly H, Guo P, Pietronigro D, Ervin-Haynes AL, Czuczman MS. An international phase II trial of single-agent lenalidomide for relapsed or refractory aggressive B-cell non-Hodgkin's lymphoma. Ann Oncol, 2011; 22: 1622-1627 doi: 10.1093/annonc/mdq626. PMID:21228334
8. Houillier C, Choquet S, Touitou V, Martin-Duverneuil N, Navarro S, Mokhtari K, Soussain C, Hoang-Xuan K. Lenalidomide monotherapy as salvage treatment for recurrent primary CNS lymphoma. Neurology, 2015; 84: 325-326 doi: 10.1212/WNL.0000000000001158. PMID:25527263
9. Cox MC, Mannino G, Lionetto L, Naso V, Simmaco M, Spiriti MA. Lenalidomide for aggressive B-cell lymphoma involving the central nervous system? Am J Hematol, 2011; 86: 957 doi: 10.1002/ajh.22148. No abstract available. PMID:21990093
10. Rubenstein JL, Treseler PA, Stewart PJ. Regression of refractory intraocular large B-cell lymphoma with lenalidomide monotherapy. J Clin Oncol, 2011; 29: 595-597 doi: 10.1200/JCO.2011.34.7252. No abstract available. PMID:21519022
11. Salati M, Tarantino V, Maiorana A, Bettelli S, Luminari S. Durable remission in a patient with leptomeningeal relapse of a MYC/BCL6-positive double-hit DLBCL treated with lenalidomide monotherapy. Hematol Oncol 2016 [Epub ahead of print] doi: 10.1002/hon.2315. PMID:27301994
12. Murawski N, Held G, Ziepert M, Kempf B, Viardot A, Hänel M, Witzens-Harig M, Mahlberg R, Rübe C, Fleckenstein J, Zwick C, Glass B, Schmitz N, Zeynalova S, Pfreundschuh M. The role of radiotherapy and intrathecal CNS prophylaxis in extralymphatic craniofacial aggressive B-cell lymphomas. Blood, 2014; 124: 720-728 doi: 10.112/bl8ood-2013-10-535021.PMID:24939657
13. Kasenda B, Loeffler J, Illerhaus G, Ferreri AJ, Rubenstein J, Batchelor TT. The role of whole brain radiation in primary CNS lymphoma. Blood, 2016; 128: 32-66 DOI:10.1182/blood-2016-01-650101 PMID:27207798
14. Kim YJ, Choe JH, Park JH, Hong YK. Efficacy of Procarbazine, Lomustine, and Vincristine Chemotherapy for Recurrent Primary Central Nervous System Lymphomas. Brain Tumor Res Treat, 2015; 3: 75-80 doi: 10.14791/btrt.2015.3.2.75. PMID:26605261
15. Rubenstein JL, Formaker P, Wang X, Chen N, Fraser E, Munster P, Damato B. Lenalidomide is highly active in recurrent CNS lymphomas: phase I investigation of lenalidomide plus rituximab and outcomes of lenalidomide as maintenance monotherapy. Hematol Oncol (ICML abstracts) 2015; 33 :175.