Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition.
We summarize our experience and propose methods for early diagnosis and treatment of intravascular large B cell lymphoma (IVL). A total of 16 patients with IVL between 1994 and 2007 were included and analyzed in this study. Predicted survival durations were short until September 2003. However, there have been marked improvement since the introduction of rituximab, and all patients responded to treatment and survived for more than 1 year following diagnosis of IVL. We propose an early clinical diagnostic strategy for starting treatment for IVL patients with quite poor performance status (PS) and in whom time is a limiting factor: (1) age >40 years, (2) fever above 38 degrees C with poor PS (ECOG 2-4), (3) lactate dehydrogenase (LDH) more than twice the upper limit of the normal level and/or sIL2R >5,000 IU/ml in serum, (4) worsening PS and/or elevation of serum LDH on a daily basis, and (5) confirmation of pathological lymphoid cells in peripheral blood or bone marrow smear and/or flow cytometry. Although accurate pathological diagnosis is quite important, time is a limiting factor for most of IVL patients. In such cases, we can start chemotherapy based on early clinical diagnostic strategy with high sensitivity and obtain good clinical outcome.
Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Ishikawa, Japan. yasum@kanazawa-med.ac.jp
Yasufumi
Y
Masaki
Lingli
L
Dong
Akio
A
Nakajima
Haruka
H
Iwao
Miyuki
M
Miki
Nozomu
N
Kurose
Eriko
E
Kinoshita
Takayuki
T
Nojima
Toshioki
T
Sawaki
Takafumi
T
Kawanami
Masao
M
Tanaka
Kumiko
K
Shimoyama
Changi
C
Kim
Masaaki
M
Fukutoku
Hiroshi
H
Kawabata
Toshihiro
T
Fukushima
Yuko
Y
Hirose
Tomoo
T
Takiguchi
Susumu
S
Konda
Susumu
S
Sugai
Hisanori
H
Umehara
D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000188:drug therapy
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab