ABSTRACT
Hodgkin lymphoma (HL) is a disease characterized by a high curability rate, and the treatment benefit-risk balance must be carefully addressed to achieve complete disease control with low risk of long-term toxicities. Most patients are treated with a combination of chemotherapy and radiotherapy, after disease staging and response to treatment evaluated by FDG PET/CT. We report the case of a 28-year-old patient concomitantly diagnosed of a Hodgkin lymphoma and active tuberculosis. Initial staging was difficult due to pulmonary and abdominal tuberculosis localization that induced FDG PET/CT hypermetabolism. Anti-tuberculosis treatment was first started, allowing secondary an early accurate Hodgkin lymphoma staging by FDG PET/CT. The patient was then treated by chemotherapy and radiotherapy. Helical TomoTherapy® was used with involved site (IS) irradiation volume was performed to decrease the high doses to organs-at-risk (OAR), especially lungs in this context of tuberculosis.
Subject(s)
Colonic Diseases/drug therapy , Hodgkin Disease/therapy , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Pulmonary/drug therapy , Adult , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antitubercular Agents/therapeutic use , Bleomycin/administration & dosage , Colonic Diseases/complications , Colonic Diseases/diagnostic imaging , Colonic Diseases/metabolism , Dacarbazine/administration & dosage , Doxorubicin/administration & dosage , Hodgkin Disease/complications , Hodgkin Disease/diagnostic imaging , Hodgkin Disease/metabolism , Humans , Lung , Lymph Nodes/diagnostic imaging , Lymph Nodes/metabolism , Male , Organs at Risk , Positron Emission Tomography Computed Tomography , Radiotherapy, Intensity-Modulated , Risk Assessment , Tomography, X-Ray Computed , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnostic imaging , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnostic imaging , Vinblastine/administration & dosageSubject(s)
Choroid Neoplasms/pathology , Lymphoma, B-Cell/pathology , Choroid Neoplasms/diagnostic imaging , Choroid Neoplasms/radiotherapy , Dose Fractionation, Radiation , Humans , Lymphoma, B-Cell/diagnostic imaging , Lymphoma, B-Cell/radiotherapy , Magnetic Resonance Imaging , Male , Middle Aged , Ultrasonography , Vision Disorders/etiologyABSTRACT
BACKGROUND: Central nervous system (CNS) relapse is an uncommon but dramatic complication of diffuse large B-cell lymphoma (DLBCL). Several studies have demonstrated the superiority of cerebrospinal fluid (CSF) flow cytometry (FCM), as compared with conventional cytology (CC), in detecting occult leptomeningeal disease. The clinical relevance of a positive FCM still has to be clarified. PATIENTS AND METHODS: We analyzed CSF from 114 DLBCL patients at diagnosis (n = 95) or at relapse (n = 19) by FCM and CC. Most patients received meningeal prophylaxis. FCM results did not influence treatment strategies. RESULTS: Fourteen samples were FCM+, versus one CC+ (also FCM+). Within all patients without neurological symptoms (n = 101), four (4%) relapsed in the CNS, with a median time to relapse of 5.2 months. Only one-fourth (25%) was FCM+ before relapse. More than one extranodal disease site and elevated lactate dehydrogenase levels were associated with an increased risk of CNS relapse. CONCLUSIONS: FCM gives far more positive results than CC. However, a positive FCM result did not translate into a significant increase in CNS relapse rate in this histologically uniform population receiving CNS prophylaxis.
Subject(s)
Central Nervous System Neoplasms/diagnosis , Flow Cytometry/methods , Immunophenotyping/methods , Lymphoma, Large B-Cell, Diffuse/cerebrospinal fluid , Lymphoma, Large B-Cell, Diffuse/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Central Nervous System Neoplasms/cerebrospinal fluid , Central Nervous System Neoplasms/secondary , Cytodiagnosis/methods , Female , Humans , Lymphoma, Large B-Cell, Diffuse/immunology , Lymphoma, Large B-Cell, Diffuse/pathology , Male , Middle Aged , Predictive Value of Tests , Prognosis , Recurrence , Young AdultABSTRACT
BACKGROUND: Revised response criteria for aggressive lymphomas have been proposed (Cheson, J Clin Oncol, 2007) stressing the role of (18)fluorodeoxyglucose-positron emission tomography (PET) in posttreatment evaluation. The value of PET after four cycles compared with the International Workshop Criteria (IWC) remains to be established. PATIENTS AND METHODS: In all, 103 patients with untreated diffuse large B-cell lymphoma were prospectively enrolled to evaluate the prognostic impact of PET after two and four cycles. RESULTS: Median age was 53 years (19-79), 68% male. The International Prognostic Index was low=22%, low-intermediate=19%, intermediate-high=33% and high risk=26%. Treatment consisted of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) (30%) or dose-intensified CHOP (70%), with rituximab (49%) or without (51%). Ninety-nine patients were evaluated by PET and IWC at four cycles: 77 (78%) had a negative PET, while 22 (22%) remained positive. The 5-year event-free survival (EFS) was 36% for patients with a positive PET versus 80% with a negative examination, whatever the response [complete response (CR) versus partial response (PR)] according to IWC (P<0.0001). Positive PET patients had a 5-year EFS of 58% if in CR/CR unconfirmed by IWC and 0% if not (P<0.0001). The same observations could be made in patients treated with and without rituximab. CONCLUSION: The integration of PET in treatment evaluation offers a powerful tool to predict outcome.
