[Adult T-cell leukemia/lymphoma in a patient on hemodialysis-resistance to CHOP, but unexpected effect and remission achieved by sobuzoxane alone].
A 66-year-old man, on thrice-weekly hemodialysis for 7 years, was referred to Chiba Cancer Center Hospital in August 2006 because of a left axillary tumor. Computed tomography revealed several enlarged lymph nodes assembling at the left axilla. The serum soluble IL-2 receptor was 47,500 U/mL, and HTLV-1 antibody was positive. His parents came from Kyushu. The pathological diagnosis was peripheral T-cell lymphoma, CD4(+). He was clinically diagnosed as having an adult T-cell leukemia/lymphoma, lymphoma type, and clinical stage II. Two courses of CHOP therapy were given to the patient, without any response. Because the patient had to undergo hemodialysis consistently, we preferred mild salvage therapy to more intensive treatment. Then, sobuzoxane (SBZ), 1,600 mg/day in two divided doses, was administered orally for 5 days. Soon thereafter, unexpectedly, the axillary tumor rapidly became small, resulting in disappearance four months later. SBZ therapy, 800 mg/day x 3 days, was continued at intervals of 7 to 8 weeks until October 2008. At the time of reporting, May 2009, the patient was well without recurrence of ATLL, and the remission has lasted 26 months or more. The reason why CHOP-resistant ATLL responded dramatically to SBZ alone is not clear, but the plasma concentration of the metabolite of SBZ was possibly very high because of renal failure. Another possibility is that hemodialysis removed the growth factor(s) or anti-apoptotic factor(s) derived from ATLL cells.
Division of Hematology-Oncology, Chiba Cancer Center Hospital.
Chikara
C
Sakai
Noriyoshi
N
Murotani
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D010879:Piperazines / Q000627:therapeutic use*; D011241:Prednisone / Q000627:therapeutic use; D012074:Remission Induction; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000627:therapeutic use
D010879:Piperazines; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; C057773:sobuzoxane; D011241:Prednisone