title: Is R-CHOP Therapy a Lymphoma Growth Factor?
abstract: This article describes the first reported case of dramatic lymphocytosis flare after initiation of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy for an indolent lymphoma. The study patient exhibited a marginal zone lymphoma with mild nodal involvement but packed infiltration of the bone marrow. After initiation of RCHOP therapy, lymphocyte count increased from 329 to 707 × 10⁹/L at day 7. Patient exhibited grade III infusion-related side effect during rituximab therapy. Lymphocyte flare was not accompanied with other clinical manifestation such as lymph node enlargement. Because patient's bone marrow aspirate showed a packed infiltration, it was hypothesized that lymphocytosis flare was a link to lymphocyte release from bone marrow and lymphocyte demargination. This report highlights the necessity to be vigilant after initiation of RCHOP therapy for lymphoma when pathologist notified a pack infiltration of the bone marrow.
authors.affiliation: 1Service d'Hématologie and 2Service d'Hématologie et de Biologie Vasculaire, Centre Hospitalier Universitaire La Conception, Marseille, France; and 3Technologies Avancées pour la Génomique et la Clinique (TAGC)/Unité INSERM U928, Marseille, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Farnault
authors.forename: Cedric
authors.initials: C
authors.lastname: Mercier
authors.forename: Yael
authors.initials: Y
authors.lastname: Berda-Haddad
authors.forename: Gerard
authors.initials: G
authors.lastname: Sebahoun
authors.forename: Regis
authors.initials: R
authors.lastname: Costello
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D006801:Humans; D008218:Lymphocytosis / Q000139:chemically induced*; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D011241:Prednisone / Q000009:adverse effects; D000069283:Rituximab; D014750:Vincristine / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone