RESUMEN
The choice of second-line chemotherapy for malignant lymphoma in cases of both Hodgkin lymphoma and non-Hodgkin lymphoma depends on the results of first-line therapies. However, the trends in first-line therapy for malignant lymphoma have undergone significant changes over the last few years. The change has resulted from three facts: 1) the concept of dose intensity had to be revised, 2) newly-found prognostic factors have shown the need for therapy that takes risk grouping into consideration, and 3) new therapies, such as immunotherapy using monoclonal antibodies, have emerged. Based on these recent trends, this paper describes salvage therapies as a "recommendation" or "guideline" for cases of relapse or therapy-resistant disease which involve standard therapeutic measures.
Asunto(s)
Enfermedad de Hodgkin/terapia , Linfoma no Hodgkin/terapia , Terapia Recuperativa , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Esquema de Medicación , Trasplante de Células Madre Hematopoyéticas , Enfermedad de Hodgkin/tratamiento farmacológico , Humanos , Linfoma de Células B/tratamiento farmacológico , Linfoma Folicular/tratamiento farmacológico , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma no Hodgkin/tratamiento farmacológico , Prednisona/administración & dosificación , Vincristina/administración & dosificaciónRESUMEN
A 34-year-old female was referred to our hospital for the evaluation of atypical lymphocytosis. Leukocyte count at diagnosis was 17,900/microl with 58% atypical lymphocytes having a convoluted nucleus and prominent nucleoli. Because the leukocyte count increased to 43,600/microl, the patient was treated with 2'deoxycoformycin followed by CHOP combination chemotherapy. However, both treatments failed to achieve remission. We planned an allogeneic bone marrow transplantation from an HLA-matched unrelated donor. The patient was treated with Ara-C and etoposide before conditioning to decrease the high leukemia burden. After administration of total body irradiation (12 Gy in six fractions) and cyclophosphamide (total dose of 120 mg/kg) unmanipulated marrow cells were infused. Under prevention of GVHD by CsA and short-term MTX, leukocyte engraft was prompt at day 16, and acute GVHD grade II was observed. Because 9.4% of residual recipient type T-cells was seen with STR analysis on day 22, we decreased the dose of Cs'A. After the occurrence of mild acute GVHD, the residual T-cell number decreased. The patient is still in complete remission for up to 22 months after BMT. We conclude that allogeneic SCT is effective for the treatment of T-PLL.