Rituximab combined with chemotherapy for treatment of primary CD5 positive diffuse large B-cell lymphoma: report of two cases and review of literature / 白血病·淋巴瘤

ABSTRACT

Objective To explore the biological characteristics of primary CD5 positive diffuse large B-cell lymphoma (DLBCL) and treatment effects of rituximab combined with different chemotherapy regimens. Methods The clinical features of 2 CD5 positive DLBCL patients (1 case with early report and 1 case with newly treated) in department of hematology of the Second Hospital of Shanxi Medical University were summarized, including bone marrow, lymph nodes morphology, flow cytometry, immunohistochemistry, and molecular biology characteristics. The treatment response of rituximab combined with different chemotherapy regimens was evaluated, and the literatures were reviewed. Results First patient was diagnosed as primary CD5 positive DLBCL with complex karyotype (leukemia stage). After the first induction chemotherapy with rituximab and VCTP regimens (4 weeks), the patient achieved complete remission of bone marrow. Spleen and lymph nodes also were reduced significantly. Eight consolidation therapy including R-VCTP regimen (2 weeks), R-Hyper-CVAD regimens for 3 courses and R-HD-MTX regimens for 4 courses were sequentially given. Cytarabine combined with and methotrexate (MTX) was performed 10 times of intrathecal injection. After the follow-up of 21 months, the disease sustained remission without central nervous system (CNS) invasiveness. Second elderly patient was diagnosed as primary CD5 positive DLBCL (nasal type), who received induction chemotherapy regimen of rituximab combined with vincristine and prednisone for 3 courses. Nasal tumor symptoms completely relieved after subsequent treatments and the local sclerotin restored. However, multiple skin lesions appeared after half a year, which were quickly alleviated after treatment of rituximab combined with COP regimen. Magnetic resonance imaging (MRI) showed that the brain parenchymal infiltration appeared. Related symptoms gradually relieved after radiotherapy and imageology also showed that infiltrates were mostly absorbed. The patient was followed up for 21 months and had the stable disease. Conclusions Primary CD5 positive DLBCL is a unique subset presented with more extranodal lesions, which occur commonly in bone marrow, skin and CNS. Rituximab combined with acute lymphoblastic leukemia chemotherapy and intrathecal chemotherapy may reduce incidence of metastatic central lesions , and improve the disease free survival rate.