Blood and Lymphatic Cancer: Targets and Therapy (May 2022)

Intravascular Large B Cell Lymphoma with CNS Involvement Successfully Treated with High-Dose Methotrexate and High-Dose Ara-C Based CNS-Directed Chemoimmunotherapy Alternating with Anthracycline Based Chemoimmunotherapy

  • Wang J,
  • Alhaj Moustafa M,
  • Kuhlman JJ,
  • Seegobin K,
  • Jiang L,
  • Gupta V,
  • Tun HW

Journal volume & issue
Vol. Volume 12
pp. 47 – 54

Abstract

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Jing Wang,1 Muhamad Alhaj Moustafa,2 Justin J Kuhlman,1 Karan Seegobin,2 Liuyan Jiang,3 Vivek Gupta,4 Han W Tun2 1Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA; 2Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA; 3Department of Pathology and Laboratory Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA; 4Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USACorrespondence: Han W Tun, Mayo Clinic Florida Division of Hematology/Oncology, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA, Tel +1 904-953-2000, Email [email protected]: Intravascular large B cell lymphoma (IVL) is a rare subtype of diffuse large B cell lymphoma confined to small blood vessels with a predilection for CNS involvement. The prognosis of IVL with CNS involvement (CNS-IVL) is extremely poor. The optimal treatment for CNS-IVL is not well defined. Thus, we report three patients with CNS-IVL successfully treated with a CNS-centric approach consisting of high-dose methotrexate (HDMTX) and high-dose Ara-C (HiDAC) based CNS-directed chemoimmunotherapy (CIT) alternating with anthracycline-based CIT. Our rationale for intensifying the CNS-directed therapy is the presence of intracerebral bleeding in two of our patients which would result in extravasation of lymphoma cells into the cerebral parenchyma with the development of CNS lymphoma. All three patients have achieved excellent therapeutic outcomes. Two patients with intracerebral bleeding have been in complete remission (CR) for about 11 years and 4 years. One patient was successfully induced into CR about 10 months ago and currently is in CR. This unique therapeutic approach should be further explored for CNS-IVL.Keywords: intravascular lymphoma, CNS involvement, CNS-directed chemoimmunotherapy, anthracycline-based chemoimmunotherapy, high-dose methotrexate, high-dose Ara-C

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