Primary cutaneous diffuse large B-cell lymphoma, leg type, in an 80-year-old female patient. Clinical case
https://doi.org/10.17650/2782-3202-2022-2-4-34-40
Abstract
Primary cutaneous diffuse large B-cell lymphoma, leg type, is diagnosed in 20-25 % cases of all primary cutaneous B-cell lymphomas, primarily in elderly women (older than 70 years). The disease has aggressive recurrent progression and worse prognosis than other variants. The standard antitumor drug therapy are such regimens as R-CHOP and CHOP-like programs including anthracycline antibiotics. Use of these programs can be limited by the presence of cardiovascular and other concomitant disorders.
Due to the limited variety of combinations of antitumor agents, low frequency of diagnosis of this immunomorphological variant of lymphoproliferative disease and absence of a single algorithm of drug therapy, every clinical case is interesting and informative.
In the presented clinical case, an 80-year-old female patient with primary cutaneous diffuse large B-cell lymphoma, leg type, and concomitant pathology of the cardiovascular system underwent 2 courses of R-CVP regimen drug therapy without anthracyclines. A significant antitumor clinical effect was achieved in the form of complete tumor regression. Treatment was not accompanied by significant toxicity which allowed to complete therapy.
About the Authors
Yu. E. RyabukhinaRussian Federation
Yulia E. Ryabukhina.
111 1st Uspenskoe Shosse, Lapino, Moscow region 143081
F. M. Abbasbeyli
Russian Federation
111 1st Uspenskoe Shosse, Lapino, Moscow region 143081
O. L. Timofeeva
Russian Federation
111 1st Uspenskoe Shosse, Lapino, Moscow region 143081
P. A. Zeynalova
Russian Federation
Department of Oncology, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University).
111 1st Uspenskoe Shosse, Lapino, Moscow region 143081; Bld. 2, 8 Trubetskaya St., Moscow 119991
A. G. Zhukov
Russian Federation
111 1st Uspenskoe Shosse, Lapino, Moscow region 143081
References
1. Willemze R., Cerroni L., Kempf W. et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019;133(16):1703-14. DOI: 10.1182/blood-2018-11-881268
2. Al-Obaidi A., Parker N.A., Choucair K. et al. Primary cutaneous diffuse large B-cell lymphoma, leg type: a case report. Cureus 2020;12(6):e8651. DOI 10.7759/cureus.8651
3. Lima M. Cutaneous primary B-cell lymphomas: from diagnosis to treatment. An Bras Dermatol 2015;90(5):687-706. DOI: 10.1590/abd1806-4841.20153638
4. Sokol L., Naghashpour M., Glass L.F. Primary cutaneous B-cell lymphomas: recent advances in diagnosis and management. Cancer Control 2012;19(3):236-44. DOI: 10.1177/107327481201900308
5. Coiffier B. When can R-CHOP not be used in an elderly patient? Oncology (Williston Park) 2013;27(2):146-8.
6. Guyot A., Ortonne N., Valeyrie-Allanore L., Bagot M. Combined treatment with rituximab and anthracycline-containing chemotherapy for primary cutaneous large B-cell lymphomas, leg type, in elderly patients. Arch Dermatol 2010;146(1):89-91. DOI: 10.1001/archdermatol.2009.345
7. Pulini S., Rupoli S., Goteri G. et al. Efficacy and safety of pegylated liposomal doxorubicin in primary cutaneous B-cell lymphomas and comparison with the commonly used therapies. Eur J Haematol 2009;82(3):184-93. DOI: 10.1111/j.1600-0609.2008.01197.x
8. Grange F., Joly P., Barbe C. et al. Improvement of survival in patients with primary cutaneous diffuse large B-cell lymphoma, leg type, in France. JAMA Dermatol 2014;150(5):535-41. DOI: 10.1001/jamadermatol.2013.7452
9. Beylot-Barry M., Mermin D., Maillard A. et al. A single-arm phase II trial of lenalidomide in relapsing or refractory primary cutaneous large B-cell lymphoma, leg type. J Invest Dermatol 2018;138(9):1982-9. DOI: 10.1016/j.jid.2018.03.1516
10. Gupta E., Accurso J., Sluzevich J. et al. Excellent outcome of immunomodulation or Bruton's tyrosine kinase inhibition in highly refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Rare Tumors 2015;7(4):164-6. DOI: 10.4081/rt.2015.6067
11. Menguy S., Prochazkova-Carlotti M., Beylot-Barry M. et al. PD-L1 and PD-L2 are differentially expressed by macrophages or tumor cells in primary cutaneous diffuse large B-cell lymphoma, leg type. Am J Surg Pathol 2018;42(3):326-34. DOI: 10.1097/PAS.0000000000000983
12. Di Raimondo C., Abdulla F.R., Zain J. et al. Rituximab, lenalidomide and pembrolizumab in refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Br J Haematol 2019;187(3):e79-e82. DOI: 10.1111/bjh.16211
13. Tadiotto Cicogna G., Ferranti M., Lazzarotto A., Alaibac M. Biological approaches to aggresive cutaneous B-cell lymphomas. Front Oncol 2019;9:1-4. DOI: 10.3389/fonc.2019.01238
14. Mareschal S., Pham-Ledard A., Viailly P.J. et al. Identification of somatic mutations in primary cutaneous diffuse large B-Cell Lymphoma, leg type by massive parallel sequencing. J Investig Dermatol 2017;137(9):1984-94. DOI: 10.1016/j.jid.2017.04.010
15. Pham-Ledard A.; Prochazkova-Carlotti M., Andrique L. et al. Multiple genetic alterations in primary cutaneous large B-cell lymphoma, leg type support a common lymphomagenesis with activated B-cell-like diffuse large B-cell lymphoma. Mod Pathol 2014;27(3):402-11. DOI: 10.1038/modpathol.2013.156
16. Mitteldorf C., Berisha A., Pfaltz M. et al. Tumor microenvironment and checkpoint molecules in primary cutaneous diffuse large B-cell lymphoma - new therapeutic targets. Am J Surg Pathol 2017;41(7):998-1004. DOI: 10.1097/PAS.0000000000000851
17. Schmittlutz K., Marks R. Current treatment options for aggressive non-Hodgkin lymphoma in elderly and frail patients: practical considerations for the hematologist. Ther Adv Hematol. 2021;12:2040 620721996484. DOI: 10.1177/2040620721996484
18. Hershman D.L., McBride R.B., Eisenberger A. et al. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol 2008;26(19):3159-65. DOI: 10.1200/JCO.2007.14.1242
19. Wieringa A., Boslooper K., Hoogendoorn M. et al. Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study. Br J Haematol. 2014;165(4):489-96. DOI: 10.1111/bjh.12765
20. Laribi K., Denizon N., Bolle D. et al. R-CVP regimen is active in frail elderly patients aged 80 or over with diffuse large B cell lymphoma. Ann Hematol 2016;95(10):1705-14. DOI: 10.1007/s00277-016-2768-x
Review
For citations:
Ryabukhina Yu.E., Abbasbeyli F.M., Timofeeva O.L., Zeynalova P.A., Zhukov A.G. Primary cutaneous diffuse large B-cell lymphoma, leg type, in an 80-year-old female patient. Clinical case. MD-Onco. 2022;2(4):34-40. (In Russ.) https://doi.org/10.17650/2782-3202-2022-2-4-34-40