title: Rituximab plus dose-reduced cyclophosphamide, mitoxantrone, vincristine, and prednisolone are effective in elderly patients with diffuse large B-cell lymphoma of the thyroid.
abstract: BACKGROUND
  Primary thyroid lymphoma is a rare disease. Although many reports have dealt with surgery followed by chemotherapy or radiation as well as combined chemoradiation, little is known about the value of immunochemotherapy alone. We present the results of systemic treatment using rituximab plus dose reduced mitoxantrone, cyclophosphamide, vincristine, and prednisolone in three elderly patients with primary diffuse large B-cell lymphoma (DLBCL) of the thyroid.
  
  
  METHODS
  Three patients aged between 86 and 93 years were found to have DLBCL of the thyroid. Lymphoma was locally advanced and deemed unresectable in one patient, whereas the remaining two patients were judged unfit for surgery. All patients were given systemic therapy with R 375 mg/m(2) on day 1, mitoxantrone 8 mg intravenously, cyclophosphamide 750 mg intravenously, and vincristine 1 mg (all given on day 2), along with 100 mg oral prednisolone on days 1-5.
  
  
  RESULTS
  Two patients were given 6 cycles and one patient was given 8 courses of treatment, and all responded with complete remission of the lymphoma. All three patients are alive without evidence of disease recurrence 16, 19, and 25 months after initiation of therapy. Side effects were leukopenia grade III and anemia grade II in one patient each, nausea/emesis grade I in two patients, and lower urinary tract infection and bronchitis in one patient each.
  
  
  CONCLUSIONS
  These data suggest that R plus dose-reduced mitoxantrone, cyclophosphamide, vincristine, and prednisolone are feasible and highly effective in elderly patients with DLBCL of the thyroid.
authors.affiliation: Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria .
authors.forename: Constanze
authors.initials: C
authors.lastname: Jonak
authors.forename: Marlene
authors.initials: M
authors.lastname: Troch
authors.forename: Leonhard
authors.initials: L
authors.lastname: Müllauer
authors.forename: Bruno
authors.initials: B
authors.lastname: Niederle
authors.forename: Martha
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Markus
authors.initials: M
authors.lastname: Raderer
mesh_terms: D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008942:Mitoxantrone / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D000069283:Rituximab; D013964:Thyroid Neoplasms / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone