内容紹介
A Case of Primary Mediastinal(Thymic)B-Cell Lymphoma Successfully Treated with the DA-EPOCH-R Regimen
Summary
Primary mediastinal(thymic)B-cell lymphoma(PMBL)is resistant to treatment when compared with diffuse large B-cell lymphoma(DLBCL). Moreover, the optimal first-line treatment of PMBL has not yet been determined. Herein, we report a case of PMBL that was successfully treated with the dose adjusted(DA)etoposide, prednisolone, vincristine, doxorubicin, and cyclophosphamide with rituximab(EPOCH-R)regimen. A-29-year-old woman was referred to our hospital with an anterior mediastinal tumor. Eight months before admission, she had visited a clinic for pain in the chest and back, but no abnormalities were found. Subsequently, her chest pain got worse, and she went to another clinic, where she was detected with an anterior mediastinal tumor and was referred to our hospital. Tumor biopsy with a thoracoscope was performed, and a diagnosis of PMBL was made. The tumor diameter was 90 mm, with invasion to the lungs and superior vena cava. The tumor had a clinical stage of IEA, and the International Prognostic Index(IPI)was low risk. She was treated with the DA-EPOCH-R regimen for 8 courses, and a complete response was achieved. A recent retrospective study of DA-EPOCH-R treatment without radiotherapy for PMBL was recently published. It showed that the event-free survival rate was 93% and the overall survival rate was 97% during a median 5-year follow-up. Thus, DA-EPOCH-R may be a potential standard treatment for PMBL.
要旨
縦隔(胸腺)原発大細胞型B細胞リンパ腫(PMBL)はびまん性大細胞型B細胞リンパ腫と比較し治療抵抗性であり,治療の第一選択は定まっていない。今回われわれは,肺と上大静脈に浸潤したPMBLにdose adjusted(DA)-EPOCH-R療法が有効であった症例を経験したので報告する。症例は29歳,女性。当院入院の8か月前から前胸部痛,背部痛を自覚し,複数の医療機関で精査を受けるも異常を指摘されず,3週間前に前医のCTで前縦隔腫瘍を認めたため当院を紹介された。胸腔鏡下縦隔腫瘍生検によりPMBLと診断された。前縦隔腫瘍は長径90 mm,肺と上大静脈への浸潤を認め,病期IEA,IPI low riskであった。DA-EPOCH-R療法を8コース施行し,完全寛解を得た。最近PMBLは,DA-EPOCH-R療法により放射線治療なしで5年EFS 93%,OS 97%と報告された。DA-EPOCH-R療法は,PMBL治療の有力な選択肢の一つとなると考えられる。
目次
Summary
Primary mediastinal(thymic)B-cell lymphoma(PMBL)is resistant to treatment when compared with diffuse large B-cell lymphoma(DLBCL). Moreover, the optimal first-line treatment of PMBL has not yet been determined. Herein, we report a case of PMBL that was successfully treated with the dose adjusted(DA)etoposide, prednisolone, vincristine, doxorubicin, and cyclophosphamide with rituximab(EPOCH-R)regimen. A-29-year-old woman was referred to our hospital with an anterior mediastinal tumor. Eight months before admission, she had visited a clinic for pain in the chest and back, but no abnormalities were found. Subsequently, her chest pain got worse, and she went to another clinic, where she was detected with an anterior mediastinal tumor and was referred to our hospital. Tumor biopsy with a thoracoscope was performed, and a diagnosis of PMBL was made. The tumor diameter was 90 mm, with invasion to the lungs and superior vena cava. The tumor had a clinical stage of IEA, and the International Prognostic Index(IPI)was low risk. She was treated with the DA-EPOCH-R regimen for 8 courses, and a complete response was achieved. A recent retrospective study of DA-EPOCH-R treatment without radiotherapy for PMBL was recently published. It showed that the event-free survival rate was 93% and the overall survival rate was 97% during a median 5-year follow-up. Thus, DA-EPOCH-R may be a potential standard treatment for PMBL.
要旨
縦隔(胸腺)原発大細胞型B細胞リンパ腫(PMBL)はびまん性大細胞型B細胞リンパ腫と比較し治療抵抗性であり,治療の第一選択は定まっていない。今回われわれは,肺と上大静脈に浸潤したPMBLにdose adjusted(DA)-EPOCH-R療法が有効であった症例を経験したので報告する。症例は29歳,女性。当院入院の8か月前から前胸部痛,背部痛を自覚し,複数の医療機関で精査を受けるも異常を指摘されず,3週間前に前医のCTで前縦隔腫瘍を認めたため当院を紹介された。胸腔鏡下縦隔腫瘍生検によりPMBLと診断された。前縦隔腫瘍は長径90 mm,肺と上大静脈への浸潤を認め,病期IEA,IPI low riskであった。DA-EPOCH-R療法を8コース施行し,完全寛解を得た。最近PMBLは,DA-EPOCH-R療法により放射線治療なしで5年EFS 93%,OS 97%と報告された。DA-EPOCH-R療法は,PMBL治療の有力な選択肢の一つとなると考えられる。