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[Thalidomide therapy in relapsed diffuse large B-cell lymphoma in elderly patients. Three cases]
Nikolett Wohner1, Gergely Varga1, Péter Szloboda2
1III. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Kútvölgyi út 4., 1125.
Insights
Thalidomide shows promise for elderly patients with relapsed diffuse large B-cell lymphoma (DLBCL), a common non-Hodgkin lymphoma (NHL). This low-toxicity treatment offers an alternative for patients ineligible for high-toxicity therapies, with two of three cases achieving complete remission.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- Diffuse large B-cell lymphoma (DLBCL) is the most common adult non-Hodgkin lymphoma (NHL).
- Elderly patients with relapsed DLBCL face treatment challenges due to high chemotherapy toxicity.
- Immunomodulatory drugs (IMiDs), like thalidomide, exhibit anti-angiogenic and immunomodulatory properties.
Observation:
- Three elderly patients with relapsed DLBCL received thalidomide (100 mg) and corticosteroids.
- Two patients had central nervous system (CNS) involvement; one had primary mediastinal disease.
- Two patients achieved complete remission and remained progression-free for 12 and 20 months.
Findings:
- Thalidomide treatment resulted in excellent responses in two elderly DLBCL patients.
- One patient with CNS involvement progressed and unfortunately deceased despite therapy.
- IMiDs demonstrate significant activity in relapsed DLBCL, particularly in elderly populations.
Implications:
- Thalidomide offers a promising, low-cost, and low-toxicity treatment option for elderly patients with relapsed DLBCL.
- This approach may be suitable for patients who cannot tolerate standard high-toxicity treatments.
- Further investigation into thalidomide's efficacy in aggressive relapsed NHL is warranted.
Abstract:
Diffuse large B-cell lymphoma (DLBCL), a high-grade lymphoproliferative disease, is the most common lymphoma in adults, representing 31% of non-Hodgkin lymphomas (NHL). In elderly patients treatment is problematic because of the high toxicity of standard chemotherapy protocols, especially in relapsed cases, where high-dose chemotherapy and haematopoietic stem cell transplantation would be the best choice. More and more data is becoming available on alternative treatment of refractory/relapsed NHL, including studies on the positive effect of thalidomide and second generation IMiDs in DLBCL, which are already part of the standard treatment protocol in myeloma multiplex and myelodysplasia. The broadening use of IMiDs is due to their anti-angiogenetic, immunmodulatory and anti-inflammatory properties. In addition, a component of the E3-ubiquitin ligase complex, named cereblon, has been described in 2010 as the molecular effector of the thalidomide signal transduction pathway. We initiated thalidomide treatment in three elderly patients with relapsed DLBCL. In two cases, patients had CNS involvement, in the third case the patient had primary mediastinal disease. Patients received 100 mg thalidomide in combination with corticosteroids. Two patients showed an excellent response reaching complete remission on imaging; these patients are progression-free 12 and 20 months after the beginning of treatment. One patient with CNS involvement progressed and deceased despite therapy. According to the literature, IMiDs have significant activity in relapsed DLBCL. Our case-report presents promising results in an elderly patient population with aggressive relapsed NHL that usually has very poor outcome, as high-toxicity treatment cannot be given to these patients. Consequently, because of its efficiency, low-cost and low-toxicity, it is recommended to consider thalidomide therapy in elderly patients with high-grade DLBCL. Orv Hetil. 2017; 158(41): 1642-1648.