[Relapsed pulmonary lymphomatoid granulomatosis grade III: curative treatment with radioimmune therapy and autologous stem cell transplantation].
METHODS
A 36-year-old woman presented with dyspnea, dry cough and severe chest pain. She had been treated for persistent shoulder pain for several months. Clinical findings were non-conclusive. Lactate dehydrogenase was slightly elevated, C-reactive protein was increased.


METHODS
A chest X-ray and subsequent computed tomography (CT) scans showed a lesion measuring 10×8 cm in the right upper pulmonary lobe. A CT-guided biopsy was obtained and the histological examination revealed a dense lymphocytic infiltrate with abundant blasts in addition to areas of necrosis and fibrosis. These findings were consistent with lymphomatoid granulomatosis grade III.


METHODS
After 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristin and prednisolone (R-CHOP), an early relapse developed which was treated with rituximab, ifosphamid, methotrexate and etoposide. Good partial remission was achieved after consolidating high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). After two years of rituximab maintenance treatment positron emission tomography (PET-CT) revealed an increase of metabolic activity. A second high-dose therapy was then combined with Y-90 ibritumomab tiuxetan, which was well tolerated. During remission the previously present lymphoma lesion of the lung was resected. Histology did not reveal any residual active lymphomatoid granulomatosis. Complete remission has so far been maintained for one year after ASCT.


CONCLUSIONS
Combination of Y-90 ibritumomab tiuxetan and high-dose chemotherapy followed by ASCT may offer an efficacious and well-tolerated targeted treatment approach for patients with relapsed lymphomatoid granulomatosis.
Friedrichs
B
B
Medizinische Klinik III, Charité Universitätsmedizin Berlin-Campus Benjamin Franklin, Berlin. birte.friedrichs@charite.de
Thiel
E
E
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use* / Q000633:toxicity; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D008230:Lymphomatoid Granulomatosis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
D000911:Antibodies, Monoclonal; C422802:ibritumomab tiuxetan