[Relapse of diffuse large B cell lymphoma to CD20-negative multiple cutaneous tumors immediately after anti-CD20 monoclonal antibody (rituximab) therapy].
A 60-year-old male was referred to our hospital because of cervical lymphadenopathy and a left hilar abnormal shadow seen on chest X-ray in May 1999. The pathological findings of the cervical lymph nodes revealed that the patient had a malignant lymphoma, of the diffuse large B cell type, at clinical stage IIIB. Immunohistochemistry demonstrated that the lymphoma cells were positive for CD11a, CD19, CD20, CD23, CD25, CD45, IgM, IgD and lambda, but negative for CD5. Although a complete remission was obtained after 8 courses of CHOP therapy, the patient relapsed 32 months later. Two courses of a half dose of CHASE therapy consisting of CPM, ara-C, VP-16 and dexamethasone, followed by rituximab (600 mg/week x4) resulted in a transient re-induction of complete remission. However, multiple cutaneous tumors became apparent just 10 days after the last rituximab therapy. Immunohistochemistry of the cutaneous tumors revealed infiltration of CD20-negative lymphoma cells. A series of chemotherapy including high-dose MTX was ineffective, and the patient died in August 2003. Autopsy findings revealed the systemic intra-capillary infiltration of CD20 negative-lymphoma cells into multiple organs, including the lungs, liver, and kidneys. A CD20 negative-clone selected by rituximab therapy appeared to have expanded in this case.
Iguchi
Tomotaka
T
First Department of Internal Medicine, Tokyo Medical University.
Miyazawa
Keisuke
K
Okabe
Seiichi
S
Kawakubo
Ken
K
Shimamoto
Takashi
T
Kuriyama
Yuzuru
Y
Ito
Yoshikazu
Y
Kimura
Yukihiko
Y
Ohyashiki
Kazuma
K
Serizawa
Hiromi
H
Iwaya
Keiici
K
Mukai
Kiyoshi
K
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002196:Capillaries / Q000473:pathology; D017809:Fatal Outcome; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009383:Neoplasms, Vascular Tissue / Q000473:pathology; D012074:Remission Induction; D000069283:Rituximab; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab