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[Relapsed pulmonary lymphomatoid granulomatosis grade III: curative treatment with radioimmune therapy and autologous stem cell transplantation].

AbstractHISTORY AND ADMISSION FINDINGS:
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.
INVESTIGATIONS:
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.
TREATMENT AND COURSE:
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.
AuthorsB Friedrichs, E Thiel
JournalDeutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 135 Issue 38 Pg. 1857-60 (Sep 2010) ISSN: 1439-4413 [Electronic] Germany
Vernacular TitlePulmonale lymphomatoide Granulomatose Grad III: kurativer Therapieansatz mit Radioimmuntherapie und autologer Stammzelltransplantation.
PMID20842604 (Publication Type: Case Reports, Journal Article)
Copyright© Georg Thieme Verlag KG Stuttgart · New York.
Chemical References
  • Antibodies, Monoclonal
  • ibritumomab tiuxetan
Topics
  • Adult
  • Antibodies, Monoclonal (therapeutic use)
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use, toxicity)
  • Combined Modality Therapy
  • Dose-Response Relationship, Drug
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Image Processing, Computer-Assisted
  • Infant
  • Lung (pathology)
  • Lung Neoplasms (diagnosis, pathology, therapy)
  • Lymphomatoid Granulomatosis (diagnosis, pathology, therapy)
  • Neoplasm Recurrence, Local (diagnosis, pathology, therapy)
  • Pneumonectomy
  • Positron-Emission Tomography
  • Tomography, X-Ray Computed

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