Cancer Res Treat.  2015 Jan;47(1):115-119. 10.4143/crt.2013.122.

Long-Term Survival after T-cell Lymphoblastic Lymphoma Treated with One Cycle of Hyper-CVAD Regimen

• Ryu IH
• Cho IS
• Ryu AJ
• Kim MG
• Jeon JW
• Kim JS
• Lee JJ
• Choi JW
• Kang DW

• KMID: 2380397
• DOI: http://doi.org/10.4143/crt.2013.122

Abstract

T-lymphoblastic lymphoma (T-LBL) is a rare form of aggressive non-Hodgkin's lymphoma. The standard approach for management of T-LBL involves intensive multiagent chemotherapy regimens for induction and consolidation phases with central nervous system prophylaxis and a maintenance phase lasting 12-18 months. We report on a case of long-term survival after one cycle of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) and high-dose methotrexate. A 30-year-old woman diagnosed with T-LBL with a large mediastinal mass underwent one cycle of hyper-CVAD. Four days after the start of treatment, the mediastinal mass was markedly reduced. Treatment continued with one cycle of consolidation chemotherapy, comprising high-dose methotrexate and high-dose cytarabine. The patient then refused all further chemotherapeutic treatment. Seven years have passed without relapse.

Keyword

Precursor T-cell lymphoblastic leukemia-lymphoma; Remission induction; CVAD protocol

MeSH Terms

Adult
Central Nervous System
Consolidation Chemotherapy
Cyclophosphamide
Cytarabine
Dexamethasone
Doxorubicin
Drug Therapy
Female
Humans
Lymphoma
Lymphoma, Non-Hodgkin
Methotrexate
Precursor Cell Lymphoblastic Leukemia-Lymphoma*
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Remission Induction
T-Lymphocytes*
Vincristine
Cyclophosphamide
Cytarabine
Dexamethasone
Doxorubicin
Methotrexate
Vincristine

Figure

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  Fig. 1. Computed tomography (CT) at initial diagnosis. (A) Chest CT scan showed a large mediastinal mass, pleural effusion. (B) Abdominal CT scan showed left para-aortic lymphadenopathy.

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  Fig. 2. Microscopic findings of the precursor T-cell lymphoblastic lymphoma from the axillary lymph node. (A) Most tumor cells show immature nuclei with fine chromatin, convoluted nuclear contours, and frequent mitotic figures (H&E staining, ×1,000). On immunohistochemical staining, tumor cells were positive for CD3 (B) CD5 (C), and CD99 (D) (B-D, ×400).

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  Fig. 3. Comparison of chest X-ray. (A) Before treatment of hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD), on April 3, 2006. (B) Chest X-ray showed that the mediastinal mass had decreased after performance of hyper-CAVD, on April 7, 2006.

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  Fig. 4. Comparison of position emission tomography-computed tomography (PET-CT), before and after treatment. (A) In March 2006, PET-CT showed the hypermetabolic mediastinal mass with multiple lymphadenopathy and pleural invasion. (B) In November 2006, after chemotherapy, PET-CT showed no hypermetabolic lesion.

Reference

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