P14.85 Brain metastasis from Hodgkin’s Lymphoma: case report and literature review

Abstract BACKGROUND Central nervous system (CNS) metastases from Hodgkin’s Lymphoma (HL) are very rare, occurring in 0.02–0.5% of cases. They are usually associated to systemic relapse of the disease. Treatment options for HL brain metastases include surgery, radiotherapy, and systemic chemotherapy. CASE REPORT A 54 year-old woman presented with thoracic pain and dyspnea. Chest CT showed a thoracic bulky mass larger than 10 cm. Biopsy confirmed HL stage IIA, nodular sclerosing variant. No typical B symptoms, such as fever, night sweats or weight loss, were observed. The patient underwent chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD scheme), followed by 30Gy mediastinic radiotherapy (RT), which led to complete remission in September 2017. After 3 months, she presented with headache and rapidly progressing gait disorder. MRI showed a contrast-enhanced lesion in the right occipital lobe, with central necrosis and massive edema. Total-body CT scan and FDG-PET ruled out either the presence of new solid tumors or systemic relapses of HL. Gross total resection of the brain lesion was carried out, and HL histology was confirmed. CSF analysis from lumbar puncture was normal. Afterwards, the patient underwent 2 cycles of high dose cytarabine, but she rapidly progressed, and received salvage RT (30 Gy). Nevertheless, further systemic progression occurred: the patient developed headache, diplopia and dysphagia and, unfortunately, she died 6 months after the diagnosis of brain metastasis. DISCUSSION Thus far, only 45 cases of CNS HL have been reported from 2000 to 2018. Whole brain radiotherapy, with or without chemotherapy, was the most common treatment. In our patient, we chose surgical resection for the solitary brain metastasis followed by chemotherapy, delaying RT at recurrence. In the literature, median overall survival of patients diagnosed with brain metastases from HL is 18 months (1–273): 17 patients (38%) showed a progression (local / systemic: 12/17 - 71%), while 28 (62%) showed complete remission after a median follow-up of 20 months (6–273). CONCLUSION Intracranial localisation of Hodgkin’s Lymphoma is a rare entity but still has to be taken into account. Advanced brain imaging could be of help in case of uncertain radiological presentation. A multidisciplinary approach is needed as there is no consensus on the best treatment to choose: surgery, radiotherapy and chemotherapy should be considered on individual basis.

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Complete Remission of Relapsed Hodgkin’s Lymphoma following Brentuximab Vedotin and Gemcitabine Combination Therapy with Severe Hypotension as Possible Treatment-Related Adverse Event: A Case Report

Case Reports in Oncology ◽

10.1159/000505830 ◽

2020 ◽

Vol 13 (1) ◽

pp. 341-346 ◽

Cited By ~ 1

Author(s):

Ibnu Purwanto ◽

Bambang P. Utomo ◽

Ahmad Ghozali

Keyword(s):

Adverse Event ◽

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Brentuximab Vedotin ◽

Hodgkin's Lymphoma ◽

High Dose ◽

High Dose Corticosteroid ◽

Severe Hypotension ◽

Dose Corticosteroid

A 40-year-old Asian female with heavily treated relapsed Hodgkin’s lymphoma showed complete remission (CR) after receiving 8 cycles of brentuximab vedotin (BV) in combination with gemcitabine as 4th line treatment. The patient remained in CR at the 18-month post-treatment follow-up. She developed severe hypotension (50/36 mm Hg) with upper and lower limb petechiae and edema after the addition of gemcitabine on the 6th cycle of BV. This adverse event resolved after 3 days of treatment with vasopressor and high-dose corticosteroid. The addition of dexamethasone for the subsequent 2 cycles successfully prevented this adverse event from recurring.

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High Dose Chemoradiotherapy and ASCT Can Overcome the Prognostic Importance of Bcl-2, Bim, and p53 in Relapsed/Refractory Hodgkin’s Lymphoma.

Blood ◽

10.1182/blood.v106.11.2073.2073 ◽

2005 ◽

Vol 106 (11) ◽

pp. 2073-2073

Author(s):

Daniel Persky ◽

Julie Teruya-Feldstein ◽

Tarun Kewalramani ◽

Pauline D. Bonner ◽

Alexia Iasonos ◽

...

Keyword(s):

Risk Factors ◽

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Comprehensive Treatment ◽

High Dose ◽

Second Line ◽

Prognostic Features ◽

Remission Duration ◽

Extranodal Disease

Abstract Introduction: Approximately twenty percent of patients with Hodgkin’s lymphoma (HL) relapse or have primary refractory disease. About 50% of these patients achieve long-term remissions after high-dose chemoradiotherapy and autologous stem cell transplantation (HDT/ASCT). At MSKCC, ICE (ifosfamide, carboplatin, etoposide) was incorporated as second-line chemotherapy prior to HDT/ASCT in a comprehensive treatment program. In addition to chemosensitive disease, a clinical prognostic model that emerged from this study identified 3 risk factors - B symptoms at relapse, extranodal disease, and complete remission duration of less than 1 year (Blood. 2001 Feb 1;97(3):616–23). This model was used to intensify treatment according to the number of risk factors, with stratification overcoming the significance of poor prognostic features (Blood. 2003 Nov 16;102(11), abstract #403). Methods: To further identify important prognostic factors, we evaluated pre-ICE biopsy specimens of patients enrolled on one of 3 IRB-approved clinical trials of HDT/ASCT. Prior studies showed that overexpression of bcl-2 and p53 have negative impact on outcome with primary therapy. We sought to determine if our comprehensive second-line program could overcome these poor prognostic features. We performed immunohistochemistry staining for bcl-2, bim (a bcl-2 family marker), and p53; samples were considered positive if any Reed-Sternberg (RS) cells stained for bcl-2 or bim, and if more than 50% stained for p53, at any staining intensity. Results: Seventy one patients had sufficient tissue available. Thirty five patients (49%) had disease progression and 28 (39%) died. Median PFS was 4.8 years, median OS was not reached, and median follow-up was 5.7 years. Bcl-2 was overexpressed in 19(27%), bim in 22 (32%), and p53 in 20 (29%) patients. Expression of bcl-2, bim, or p53 had no significant association with PFS or OS. Five-year PFS rates for positive vs. negative cases were 52.6% vs 50% for bcl-2, 54.5% vs 50% for bim, and 50% vs 51% for p53 (all p=NS). The 3 factor clinical model (B symptoms at relapse, extranodal disease and complete remission duration of less than 1 year) remained highly significant (0/1 vs 2/3 factors) for PFS and OS (p=0.002 and p=0.0003, respectively). Conclusion: Despite the evidence that p53 and bcl-2 overexpression may predict a worse prognosis with initial treatment, it appears that the approach of incorporating ICE and HDT/ASCT may overcome the significance of these biological markers at relapse. Further studies will focus on other pathways that are thought to play a role in relapsed/refractory HL outcomes. Bim is a novel pro-apoptotic marker from the bcl-2 family that is expressed on RS cells and suggests a role in the pathogenesis of HL. Future studies will focus on its role in both initial and relapsed/refractory setting.

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Complete Remission After Repeated Trofosfamide Treatment in Relapsing High-Grade Malignant Non-Hodgkin'S Lymphoma—A Case Report

Acta Oncologica ◽

10.3109/02841869409083956 ◽

1994 ◽

Vol 33 (7) ◽

pp. 831-831 ◽

Cited By ~ 3

Author(s):

Jan Norum

Keyword(s):

Case Report ◽

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

High Grade ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

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A pioneer experience in Malaysia on In-house Radio-labelling of 131I-rituximab in the treatment of Non-Hodgkin's Lymphoma and a case report of high dose 131I-rituximab-BEAM conditioning autologous transplant

Applied Radiation and Isotopes ◽

10.1016/j.apradiso.2016.07.016 ◽

2016 ◽

Vol 116 ◽

pp. 13-21

Author(s):

Jew Win Kuan ◽

Chiong Soon Law ◽

Xiang Qi Wong ◽

Ching Tiong Ko ◽

Zool Hilmi Awang ◽

...

Keyword(s):

Case Report ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Autologous Transplant ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Radio Labelling

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A novel treatment of childhood lymphoblastic non-Hodgkin's lymphoma: early and intermittent use of teniposide plus cytarabine

Blood ◽

10.1182/blood.v66.5.1110.bloodjournal6651110 ◽

1985 ◽

Vol 66 (5) ◽

pp. 1110-1114

Author(s):

GV Dahl ◽

G Rivera ◽

CH Pui ◽

J Jr Mirro ◽

J Ochs ◽

...

Keyword(s):

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Lymphoblastic Leukemia ◽

Alkylating Agents ◽

Central Nervous System Involvement ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Early Therapy ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

We treated 24 children and adolescents with stage III or IV lymphoblastic non-Hodgkin's lymphoma, using a protocol designed for patients with poor-prognosis acute lymphoblastic leukemia (ALL). Early therapy consisted of teniposide plus cytarabine administered before and immediately after prednisone, vincristine, and asparaginase. The two- drug combination was also given intermittently with continuous 6- mercaptopurine and methotrexate during the first year of continuation chemotherapy. Periodic intrathecal methotrexate and delayed cranial irradiation were used to prevent central nervous system involvement. Anthracycline compounds, alkylating agents, high-dose methotrexate, and involved-field irradiation were not used in any phase of treatment. Twenty-two (96%) of the 23 evaluable patients achieved complete remission. With a median follow-up of 2 1/2 years, only four patients have relapsed; the remainder have been disease-free for eight months to more than five years. The projected four-year continuous complete remission rate is 73% for all patients and 79% for the 19 with mediastinal involvement at diagnosis. These results demonstrate that use of teniposide plus cytarabine with an otherwise conventional plan of ALL therapy is an effective approach to the treatment of childhood lymphoblastic lymphoma.

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Treatment of non-Hodgkin's lymphoma with marrow transplantation in identical twins

Blood ◽

10.1182/blood.v58.3.509.509 ◽

1981 ◽

Vol 58 (3) ◽

pp. 509-513 ◽

Cited By ~ 53

Author(s):

FR Appelbaum ◽

A Fefer ◽

MA Cheever ◽

CD Buckner ◽

PD Greenberg ◽

...

Keyword(s):

Complete Remission ◽

Marrow Transplantation ◽

Hodgkin’S Lymphoma ◽

High Dose Chemotherapy ◽

Marrow Transplant ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Well Differentiated

Abstract Eight patients with disseminated non-Hodgkin's lymphoma who failed conventional combination chemotherapy were treated with high-dose chemotherapy, a supralethal dose of total-body irradiation, and a bone marrow transplant from a normal identical twin. Seven patients experienced complete remission. Four of the seven patients (two with diffuse poorly differentiated lymphocytic lymphoma, one with composite lymphoma, and one with diffuse moderately well differentiated lymphocytic lymphoma) remain in complete unmaintained remission 12–126 mo from transplantation. One patient relapsed after 10 mo but was retreated and is alive in unmaintained complete remission 73 mo from transplantation. One patient died of Pseudomonas pneumonia while in complete remission and one patient relapsed and died of progressive lymphoma. These results demonstrate that intensive chemoradiotherapy and twin marrow transplantation can induce frequent and enduring remissions in patients with disseminated non-Hodgkin's lymphoma who have failed conventional therapy.

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High-Dose Therapy and Autologous Hematopoietic Progenitor Cells Transplantation for Recurrent or Refractory Hodgkin's Lymphoma: Analysis of King Hussein Cancer Center Results and Prognostic Variables

ISRN Oncology ◽

10.5402/2012/249124 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Fawzi Abdel-Rahman ◽

Ayad Hussein ◽

Mohammad Aljamily ◽

Abdulhadi Al-Zaben ◽

Nilly Hussein ◽

...

Keyword(s):

Overall Survival ◽

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Autologous Transplantation ◽

Conditioning Regimen ◽

Disease Status ◽

Hodgkin's Lymphoma ◽

Cancer Center ◽

High Dose ◽

The Impact

Purpose. to evaluate the outcome of patients with Hodgkin’s lymphoma who underwent autologous transplantation at KHCC bone marrow transplant program. Patients and Methods. Over 6 years, 63 patients with relapsed or refractory Hodgkin’s lymphoma underwent high dose chemotherapy followed by autologous transplant. There were 25.4% patients in complete remission (CR), 71.4% with chemotherapy responsive disease at the time of transplant. Prior to conditioning regimen, 56% received two chemotherapy lines, and, 44% received more than two lines. Results. The main outcomes of the study are the rate of complete remission at day 100, overall survival (OS), relapse-free survival (RFS), The impact of the following variables on OS and RFS: (a) disease status at the time of transplant, (b) number of chemotherapy lines prior to conditioning, (c) age group, (d) time of relapse < or >12 months were investigated. The CR at day 100 was 57%. The median overall survival for the whole group was 40.6 months; the median RFS was 20 months. The only factor which significantly impacts the study outcomes was the number of chemotherapy lines prior to conditioning on OS in favor of patients received two lines. Conclusion. In our study only the number of chemotherapy lines received before conditioning had statistically significant impact on OS.

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A novel treatment of childhood lymphoblastic non-Hodgkin's lymphoma: early and intermittent use of teniposide plus cytarabine

Blood ◽

10.1182/blood.v66.5.1110.1110 ◽

1985 ◽

Vol 66 (5) ◽

pp. 1110-1114 ◽

Cited By ~ 41

Author(s):

GV Dahl ◽

G Rivera ◽

CH Pui ◽

J Jr Mirro ◽

J Ochs ◽

...

Keyword(s):

Complete Remission ◽

Hodgkin’S Lymphoma ◽

Lymphoblastic Leukemia ◽

Alkylating Agents ◽

Central Nervous System Involvement ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Early Therapy ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma

Abstract We treated 24 children and adolescents with stage III or IV lymphoblastic non-Hodgkin's lymphoma, using a protocol designed for patients with poor-prognosis acute lymphoblastic leukemia (ALL). Early therapy consisted of teniposide plus cytarabine administered before and immediately after prednisone, vincristine, and asparaginase. The two- drug combination was also given intermittently with continuous 6- mercaptopurine and methotrexate during the first year of continuation chemotherapy. Periodic intrathecal methotrexate and delayed cranial irradiation were used to prevent central nervous system involvement. Anthracycline compounds, alkylating agents, high-dose methotrexate, and involved-field irradiation were not used in any phase of treatment. Twenty-two (96%) of the 23 evaluable patients achieved complete remission. With a median follow-up of 2 1/2 years, only four patients have relapsed; the remainder have been disease-free for eight months to more than five years. The projected four-year continuous complete remission rate is 73% for all patients and 79% for the 19 with mediastinal involvement at diagnosis. These results demonstrate that use of teniposide plus cytarabine with an otherwise conventional plan of ALL therapy is an effective approach to the treatment of childhood lymphoblastic lymphoma.

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Treatment of non-Hodgkin's lymphoma with marrow transplantation in identical twins

Blood ◽

10.1182/blood.v58.3.509.bloodjournal583509 ◽

1981 ◽

Vol 58 (3) ◽

pp. 509-513

Author(s):

FR Appelbaum ◽

A Fefer ◽

MA Cheever ◽

CD Buckner ◽

PD Greenberg ◽

...

Keyword(s):

Complete Remission ◽

Marrow Transplantation ◽

Hodgkin’S Lymphoma ◽

High Dose Chemotherapy ◽

Marrow Transplant ◽

Hodgkin's Lymphoma ◽

High Dose ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

Well Differentiated

Eight patients with disseminated non-Hodgkin's lymphoma who failed conventional combination chemotherapy were treated with high-dose chemotherapy, a supralethal dose of total-body irradiation, and a bone marrow transplant from a normal identical twin. Seven patients experienced complete remission. Four of the seven patients (two with diffuse poorly differentiated lymphocytic lymphoma, one with composite lymphoma, and one with diffuse moderately well differentiated lymphocytic lymphoma) remain in complete unmaintained remission 12–126 mo from transplantation. One patient relapsed after 10 mo but was retreated and is alive in unmaintained complete remission 73 mo from transplantation. One patient died of Pseudomonas pneumonia while in complete remission and one patient relapsed and died of progressive lymphoma. These results demonstrate that intensive chemoradiotherapy and twin marrow transplantation can induce frequent and enduring remissions in patients with disseminated non-Hodgkin's lymphoma who have failed conventional therapy.

Download Full-text