Treatment of CNS involvement of non-Hodgkin's lymphoma with short-term cerebrospinal irradiation, high-dose chemotherapy, and autologous bone marrow transplantation. A case report of a 12-year-old patient.
A 12-year-old patient with non-Hodgkin's lymphoma, who developed central nervous system (CNS) relapse, was successfully treated with the following new regimen: cerebrospinal irradiation (CSpRT), high-dose chemotherapy, and autologous bone marrow transplantation (ABMT). He received remission induction therapy comprising intrathecal methotrexate and systemic chemotherapy, followed by cranial and spinal irradiations in doses of 2,000 cGy in 10 fractions over 5 days, and 1,200 cGy in 6 fractions over 3 days, respectively. He then received chemotherapy comprising 4 infusions of 1 g/m2 cytosine arabinoside and an intravenous injection of 4 mg/kg ACNU. His bone marrow, collected and cryopreserved after the remission induction therapy, was infused immediately after the high-dose chemotherapy. The granulocyte and platelet counts reached the nadir level on days 10 and 6 after ABMT, respectively, gradually recovering to the normal level in about 1 month. Neither severe infection nor bleeding was noted during the aplastic phase. No neurological deficits have been observed for 12 months. The short-time CSpRT and high-dose chemotherapy followed by ABMT are thus demonstrated to reduce neurotoxicities and bone marrow toxicities and to produce a good therapeutic effect against CNS involvement in lymphoma.
Ishii
E
E
Department of Pediatrics, Faculty of Medicine, Kyushu University, Japan.
Nakayama
H
H
Hayabuchi
N
N
Hara
T
T
Mizuno
Y
Y
Yamamoto
M
M
Inaba
S
S
Ueda
K
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local; D011882:Radiotherapy, High-Energy; D013120:Spinal Cord Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery