Diffuse Large B Cell Lymphoma with Extensive Cutaneous Relapse

Area of Science:

• Hematology
• Oncology
• Dermatology

Background:

• Diffuse large B cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
• Cutaneous involvement in DLBCL relapse is uncommon but can be extensive.
• Understanding patterns of relapse is crucial for effective treatment strategies.

Purpose of the Study:

• To report a case of DLBCL with extensive, previously uncharacterized cutaneous relapse.
• To analyze the treatment response and potential mechanisms of rituximab resistance in this case.
• To discuss optimal management strategies for DLBCL with extensive skin involvement.

Main Methods:

• Case report of a 59-year-old male diagnosed with DLBCL.
• Initial treatment with R-CHOP chemotherapy.
• Management of extensive cutaneous relapse with R-DHAP and R-ICE salvage chemotherapy.
• Diagnostic confirmation via cervical lymph node and skin biopsies, including immunophenotyping and FISH analysis.
• Disease monitoring with PET-CT scans.

Main Results:

• The patient achieved initial remission after R-CHOP.
• Developed widespread cutaneous relapse with CD20+, BCL2+, MUM1+, BCL6+ lymphoma infiltration.
• Showed no response to R-DHAP but achieved second complete remission with R-ICE salvage chemotherapy.
• The relapse pattern suggested rituximab resistance, favoring skin involvement.

Conclusions:

• DLBCL can present with extensive cutaneous relapse, even without prior skin involvement.
• Salvage chemotherapy regimens like R-ICE are effective in achieving remission in such cases.
• Autologous peripheral blood stem cell transplantation is recommended following salvage chemotherapy for DLBCL with extensive cutaneous relapse.