title: Rapid and sustained response of an intra- and extracranial large cell lymphoma mass to liposomal intrathecal Ara-C and R-MegaCEOP systemic chemotherapy.
abstract: Prognosis of patients suffering from secondary central nervous system (CNS) lymphoma is dismal. Intracranial spread of a lymphoma arising in adjacent extranodal tissues is a rare event. A 32-year-old patient was diagnosed with progressive diffuse large B-cell lymphoma (DLBCL) with extra- and intracranial localization. He complained of headache, left diplopia, marked rigidity of the neck muscles, and difficulty in swallowing and articulating words, caused by bilateral palsy of the XII cranial nerve. Computed tomography (CT) and positron emission tomography (PET) scans showed disease localizations in the occipital-cervical soft tissue, and cerebellar parenchyma. Due to the severity of the clinical picture, high-dose dexamethasone was immediately administered. Mild improvement was observed during the first 2 days of treatment, but dramatic reduction of symptoms and nerve palsy was documented only in the 48 h after the first intrathecal administration of liposomal Ara-C. Systemic R-MegaCEOP chemotherapy was started 7 days later. Concomitant intrathecal liposomal Ara-C injections were continued for a total of nine administrations during the eight cycles of immunochemotherapy without any toxicity observed. Interim and post-therapy PET showed complete resolution of radionuclide accumulation in the involved sites. Consolidation radiotherapy (36 Gy) was administered in involved areas after the completion of the immunochemotherapy program. At the time of writing, no cumulative neurotoxicity is evident at follow-up of 17 months from diagnosis and 9 months after the overall therapeutic program has been accomplished.
authors.affiliation: Institute of Oncohematology - Autotransplantation, University of Perugia, Santa Maria Hospital, Terni, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falchi
authors.forename: Marco
authors.initials: M
authors.lastname: Gunnellini
authors.forename: Laura
authors.initials: L
authors.lastname: Franco
authors.forename: Patrizia
authors.initials: P
authors.lastname: Ferrazza
authors.forename: Stefano
authors.initials: S
authors.lastname: Ascani
authors.forename: Anna Marina
authors.initials: AM
authors.lastname: Liberati
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D003561:Cytarabine / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007278:Injections, Spinal; D008081:Liposomes / Q000008:administration & dosage; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods; D011859:Radiography; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D000964:Antimetabolites, Antineoplastic; D008081:Liposomes; D003561:Cytarabine
references.citation: Expert Opin Pharmacother. 2008 Feb;9(2):301-9
references.pmid: 18201152
references.citation: Ann Hematol. 2009 Mar;88(3):193-201
references.pmid: 19050889
references.citation: Med Pediatr Oncol. 1990;18(2):136-42
references.pmid: 2304422
references.citation: J Clin Oncol. 2006 Mar 10;24(8):1281-8
references.pmid: 16525183
references.citation: Br J Haematol. 2005 Oct;131(1):13-21
references.pmid: 16173958
references.citation: Ann Oncol. 2007 Jan;18(1):149-157
references.pmid: 17018708
references.citation: Ann Oncol. 2000 Jun;11(6):685-90
references.pmid: 10942056
references.citation: Blood. 1998 Feb 15;91(4):1178-84
references.pmid: 9454747
references.citation: Acta Oncol. 1996;35(6):703-8
references.pmid: 8938217
references.citation: J Clin Oncol. 2007 Sep 1;25(25):3915-22
references.pmid: 17761975
references.citation: Eur J Cancer. 2000 Sep;36(14):1762-8
references.pmid: 10974623
references.citation: Blood. 2003 Jan 15;101(2):466-8
references.pmid: 12393404
references.citation: Onkologie. 2003 Aug;26(4):351-4
references.pmid: 12972702
references.citation: Ann Hematol. 2006 Jan;85(1):45-50
references.pmid: 16132909
references.citation: Cancer Res. 1970 Nov;30(11):2627-35
references.pmid: 5530557
references.citation: Biol Blood Marrow Transplant. 2005 Feb;11(2):93-100
references.pmid: 15682069
references.citation: Ann Oncol. 2002 Jul;13(7):1099-107
references.pmid: 12176790
references.citation: J Neurooncol. 2007 Aug;84(1):107-17
references.pmid: 17332946