Rituximab-Related APF in Diffuse Large B-Cell Lymphoma
Rituximab-Related APF in Diffuse Large B-Cell Lymphoma
A 51-year-old woman was admitted to our department for repeated upper abdominal pain and weight loss on April 20, 2012. An electronic gastroscope detected a 2.0 × 2.0 × 0.6-cm mucosa uplift in the greater curvature of the gastric body near the rear wall. The gastric mucosa biopsy specimen revealed diffuse large B-cell non-Hodgkin lymphoma that was identified by immunohistochemistry, with gastric mucosa cells that expressed CD20, Bcl-2, and MUM-1 but were negative for cyclin D1 and CD10. Ki-67 expression was 85%. The patient was treated with an R-CHOP (375 mg/m/d rituximab, 750 mg/m/d cyclophosphamide, 4 mg/d vindesine, 60 mg/m/d epirubicin, and 15 mg/d dexamethasone) regimen. The mucosa uplift disappeared after two cycles of R-CHOP. Before the fifth cycle of R-CHOP, the patient had slight shortness of breath after the event, and a computed tomography (CT) scan confirmed the presence of bilateral ground-glass opacities Image 1A. Pulmonary function tests demonstrated a restrictive pattern and a diffusion deficit consistent with pulmonary fibrosis. The lung biopsy specimen revealed areas of pulmonary fibrosis and the presence of inflammatory cells but was negative for other pathogens Image 2. Before treatment, a radioimmunoassay kit (Beijing North Institute of Biological Technology, Beijing, China) confirmed that the patient had normal levels of TNF-α (4.2 fmol/mL; normal range, 0–30 fmol/mL). Three weeks later, however, the levels of TNF-α after treatment with R-CHOP had increased above 315.7 fmol/mL. The patient was treated with intravenous methylprednisolone (1 mg/kg/d) and oxygen administration. She had a dramatic recovery that was confirmed by a repeated CT scan Image 1B, and the levels of TNF-α returned to normal after 2 weeks of methylprednisolone treatment. The patient was treated with two cycles of a cyclophosphamide, vindesine, epirubicin, and dexamethasone regimen with a standard dose, and rituximab therapy was withdrawn from treatment. At the same time, the levels of TNF-α did not increase. The patient has remained healthy without therapy for 2 years.
(Enlarge Image)
Image 1.
A, Computed tomography scan confirmed the presence of bilateral ground-glass opacities. B, Repeated computed tomography scan showed a dramatic recovery after 2 weeks of methylprednisolone treatment.
(Enlarge Image)
Image 2.
The lung biopsy specimen revealed areas of pulmonary fibrosis and the presence of inflammatory cells. (H&E, ×400)
Case Report
A 51-year-old woman was admitted to our department for repeated upper abdominal pain and weight loss on April 20, 2012. An electronic gastroscope detected a 2.0 × 2.0 × 0.6-cm mucosa uplift in the greater curvature of the gastric body near the rear wall. The gastric mucosa biopsy specimen revealed diffuse large B-cell non-Hodgkin lymphoma that was identified by immunohistochemistry, with gastric mucosa cells that expressed CD20, Bcl-2, and MUM-1 but were negative for cyclin D1 and CD10. Ki-67 expression was 85%. The patient was treated with an R-CHOP (375 mg/m/d rituximab, 750 mg/m/d cyclophosphamide, 4 mg/d vindesine, 60 mg/m/d epirubicin, and 15 mg/d dexamethasone) regimen. The mucosa uplift disappeared after two cycles of R-CHOP. Before the fifth cycle of R-CHOP, the patient had slight shortness of breath after the event, and a computed tomography (CT) scan confirmed the presence of bilateral ground-glass opacities Image 1A. Pulmonary function tests demonstrated a restrictive pattern and a diffusion deficit consistent with pulmonary fibrosis. The lung biopsy specimen revealed areas of pulmonary fibrosis and the presence of inflammatory cells but was negative for other pathogens Image 2. Before treatment, a radioimmunoassay kit (Beijing North Institute of Biological Technology, Beijing, China) confirmed that the patient had normal levels of TNF-α (4.2 fmol/mL; normal range, 0–30 fmol/mL). Three weeks later, however, the levels of TNF-α after treatment with R-CHOP had increased above 315.7 fmol/mL. The patient was treated with intravenous methylprednisolone (1 mg/kg/d) and oxygen administration. She had a dramatic recovery that was confirmed by a repeated CT scan Image 1B, and the levels of TNF-α returned to normal after 2 weeks of methylprednisolone treatment. The patient was treated with two cycles of a cyclophosphamide, vindesine, epirubicin, and dexamethasone regimen with a standard dose, and rituximab therapy was withdrawn from treatment. At the same time, the levels of TNF-α did not increase. The patient has remained healthy without therapy for 2 years.
(Enlarge Image)
Image 1.
A, Computed tomography scan confirmed the presence of bilateral ground-glass opacities. B, Repeated computed tomography scan showed a dramatic recovery after 2 weeks of methylprednisolone treatment.
(Enlarge Image)
Image 2.
The lung biopsy specimen revealed areas of pulmonary fibrosis and the presence of inflammatory cells. (H&E, ×400)
