title: [Successful treatment with combination of plasma exchange and chemotherapy for CD5-positive primary hepatosplenic diffuse large B-cell lymphoma complicated with acute liver injury].
abstract: Primary hepatosplenic CD5-positive diffuse large B cell lymphoma (CD5⁺ DLBCL) has recently been characterized as showing hepatosplenomegaly without lymphadenopathy, a portal and intrasinusoidal pattern of infiltration in the liver, and bone marrow invasion by lymphoma cells, without intravascular involvement. A 45-year-old man presented with fever and malaise in June 2013. Computed tomography showed hepatosplenomegaly and multiple liver tumors without lymphadenopathy. An ultrasonography-guided needle biopsy of the liver mass revealed portal and intrasinusoidal infiltration of CD5⁺CD20⁺ lymphoma cells and large numbers of destroyed hepatocytes. These findings were diagnostic of primary hepatosplenic CD5⁺ DLBCL. Upon admission, lymphoma cells also appeared in the peripheral blood and serum hepatocyte growth factor (HGF) was markedly elevated. A bone marrow biopsy revealed extensive invasion by lymphoma cells. Seven days after admission, his laboratory data showed elevated aminotransferase and serum creatinine levels. Therefore, dose-reduced CH(O)P, with rituximab (R-CHOP) therapy, plasma exchange, and continuous hemodiafiltration, was initiated. The patient achieved complete remission after 4 courses of R-CHOP therapy. HGF is useful for predicting acute liver damage. If the HGF level is high, remission induction therapy, with plasma exchange, is necessary at an early stage.
authors.affiliation: Department of Gastroenterology and Hematology/Clinical Oncology, Internal Medicine, Steel Memorial Muroran Hospital.
authors.forename: Masanori
authors.initials: M
authors.lastname: Sato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuroda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Makoto
authors.initials: M
authors.lastname: Usami
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Abe
authors.forename: Tamaki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Fujii
authors.forename: Masahiro
authors.initials: M
authors.lastname: Maeda
authors.forename: Miri
authors.initials: M
authors.lastname: Fujita
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kanari
authors.forename: Teppei
authors.initials: T
authors.lastname: Matsuno
authors.forename: Wataru
authors.initials: W
authors.lastname: Jomen
authors.forename: Junji
authors.initials: J
authors.lastname: Kato
mesh_terms: D000208:Acute Disease; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018956:CD5 Antigens / Q000276:immunology; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016393:Lymphoma, B-Cell / Q000150:complications / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018956:CD5 Antigens; D000069283:Rituximab