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Long-term complete remission following tandem autologous stem cell transplantation and consolidative radiotherapy for refractory mediastinal gray-zone lymphoma

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Abstract

Mediastinal gray zone lymphoma (MGZL) is a provisional entity with intermediate features between classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma. Outcomes for patients with MGZL are reportedly poorer than those for patients with cHL or primary mediastinal large B-cell lymphoma. Additionally, no standard management guidelines for patients with MGZL are available, primarily due to its recent identification, rarity, and challenges in diagnosis. Although recent several studies have suggested dose-adjusted EPOCH-R (etoposide, doxorubicin, vincristine, cyclophosphamide, prednisolone, and rituximab) may improve outcomes in patients with MGZL, numerous patients still suffer from relapsed/refractory MGZL, and the optimal management for such patients remains uncertain. Here, we report the first case of successful treatment of refractory MGZL by tandem high-dose chemotherapy supported by autologous stem cell transplantations (auto-SCTs) and consolidative radiotherapy (RT). To date, the patient remains in CR 33 months after the completion of RT, with no significant complications. This case suggests that tandem auto-SCTs may be a promising therapeutic option for relapsed/refractory MGZL.

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References

  1. Swerdlow S, Campo E, Harris N, Jaffe E, Pileri S, Stein H, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th edn., International Agency for Research on Cancer; 2017.

  2. Kritharis A, Pilichowska M, Evens AM. How I manage patients with grey zone lymphoma. Br J Haematol. 2016;174:345–50.

    Article  PubMed  Google Scholar 

  3. Evens AM, Kanakry JA, Sehn LH, Kritharis A, Feldman T, Kroll A, et al. Gray zone lymphoma with features intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma: characteristics, outcomes, and prognostication among a large multicenter cohort. Am J Hematol. 2015;90:778 – 83.

    Article  CAS  PubMed  Google Scholar 

  4. Wilson WH, Pittaluga S, Nicolae A, Camphausen K, Shovlin M, Steinberg SM, et al. A prospective study of mediastinal gray-zone lymphoma. Blood. 2014;124:1563–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Campo E, Swerdlow SH, Harris NL, Pileri S, Stein H, Jaffe ES. The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications. Blood. 2011;117:5019–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sarkozy C, Molina T, Ghesquieres H, Michallet AS, Dupuis J, Damotte D, et al. Mediastinal gray zone lymphoma: clinico-pathological characteristics and outcomes of 99 patients from the Lymphoma Study Association. Haematologica. 2017;102:150–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Morschhauser F, Brice P, Ferme C, Divine M, Salles G, Bouabdallah R, et al. Risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin’s lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM study group. J Clin Oncol. 2008;26:5980–7.

    Article  PubMed  Google Scholar 

  8. Papadopoulos KP, Noguera-Irizarry W, Hesdorffer CS. Tandem transplantation in lymphoma. Bone Marrow Transplant. 2001;28:529 – 35.

    Article  CAS  PubMed  Google Scholar 

  9. Milgrom SA, Jauhari S, Plastaras JP, Nieto Y, Dabaja BS, Pinnix CC, et al. A multi-institutional analysis of peritransplantation radiotherapy in patients with relapsed/refractory Hodgkin lymphoma undergoing autologous stem cell transplantation. Cancer. 2017;123:1363–71.

    Article  CAS  PubMed  Google Scholar 

  10. Kahn S, Flowers C, Xu Z, Esiashvili N. Does the addition of involved field radiotherapy to high-dose chemotherapy and stem cell transplantation improve outcomes for patients with relapsed/refractory Hodgkin lymphoma? Int J Radiat Oncol Biol Phys. 2011;81:175 – 80.

    Article  PubMed  Google Scholar 

  11. Moskowitz CH, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, et al. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin’s lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015;385:1853–62.

    Article  CAS  PubMed  Google Scholar 

  12. Ansell SM, Lesokhin AM, Borrello I, Halwani A, Scott EC, Gutierrez M, et al. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin’s lymphoma. N Engl J Med. 2015;372:311–9.

    Article  CAS  PubMed  Google Scholar 

  13. Armand P, Shipp MA, Ribrag V, Michot JM, Zinzani PL, Kuruvilla J, et al. Programmed death-1 blockade with pembrolizumab in patients with classical Hodgkin lymphoma after brentuximab vedotin failure. J Clin Oncol. 2016;34(31):3733–39. https://doi.org/10.1200/JCO.2016.67.3467.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Melani C, Major A, Schowinsky J, Roschewski M, Pittaluga S, Jaffe ES, et al. PD-1 blockade in mediastinal gray-zone lymphoma. N Engl J Med. 2017;377:89–91.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chen YB, Li S, Fisher DC, Driscoll J, Del Rio C, Abramson J, et al. Phase II trial of tandem high-dose chemotherapy with autologous stem cell transplantation followed by reduced-intensity allogeneic stem cell transplantation for patients with high-risk lymphoma. Biol Blood Marrow Transplant. 2015;21:1583–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Hematology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Koji Takaishi, Tomoya Muto, Naoya Mimura, Jun Takiguchi, Yuhei Nagao, Nagisa Oshima-Hasegawa, Shokichi Tsukamoto, Yusuke Takeda, Shio Mitsukawa, Masahiro Takeuchi, Chikako Ohwada, Tohru Iseki, Chiaki Nakaseko & Emiko Sakaida

  2. Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan

    Naoya Mimura, Shio Mitsukawa & Tohru Iseki

  3. Department of Pathology, Chiba University Hospital, Chiba, Japan

    Satoshi Ota

  4. Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan

    Chiaki Nakaseko

Authors
  1. Koji Takaishi
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  2. Tomoya Muto
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  3. Naoya Mimura
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  4. Jun Takiguchi
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  5. Yuhei Nagao
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  6. Nagisa Oshima-Hasegawa
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  7. Shokichi Tsukamoto
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  8. Yusuke Takeda
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  9. Shio Mitsukawa
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  10. Masahiro Takeuchi
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  11. Chikako Ohwada
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  12. Satoshi Ota
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  13. Tohru Iseki
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  14. Chiaki Nakaseko
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  15. Emiko Sakaida
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Corresponding author

Correspondence to Emiko Sakaida.

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The authors have no competing financial interests to declare.

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Takaishi, K., Muto, T., Mimura, N. et al. Long-term complete remission following tandem autologous stem cell transplantation and consolidative radiotherapy for refractory mediastinal gray-zone lymphoma. Int J Hematol 108, 452–455 (2018). https://doi.org/10.1007/s12185-018-2471-x

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  • DOI: https://doi.org/10.1007/s12185-018-2471-x

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