Haematologica 2002; 87:(04)ELT22
[Medline] [prev] [index] [next]Combined systemic and intrathecal chemotherapy plus radiotherapy in testicular lymphoma: a report of two cases
Massimo Magagnoli, Monica Balzarotti, Luca Castagna, Alexia Bertuzzi, Andrea Nozza, and Armando Santoro
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Milan, Italy
Correspondence: Massimo Magagnoli, MD, Departmenti of Medical Oncology and Hematology, Istituto Clinico Humanitas- Via Manzoni 56, 20089 Rozzano, Italy. Tel: +39-02-82244533; fax: +39-02-82244590. E-mail: massimo.magagnoli@humanitas.it
Primary testicular lymphoma, the most common testicular malignancy in the elderly, accounts for only 1% of all non-Hodgkin's lymphomas (NHL).1 Disease course is usually aggressive, with widespread organ involvement. Retrospective analyses show a poor prognosis for this presentation, independenly from the stage at diagnosis. Relapse rate is high, ranging approximately from 50% to 80% with a third of the patients relapsing in the central nervous system (CNS) or in the contralateral testis.2-4 Doxorubicin-based regimens alone appear unable to cure the majority of patients and new specifically designed approaches are needed.5This report concerns two patients with diffuse large cell NHL of the testis treated at our institution with a combined approach, taking into account the risk of both local and systemic relapse. Prophylactic intrathecal (IT) chemotherapy and intermediate-high dose methotrexate (MTX) / cytarabine (ARA-C) were added6,7 to classical CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone);8 locoregional radiotherapy (RT) including to the contralateral testis was planned for limited stages. The patient's characteristics are shown in Table 1, and the treatment plan in Figure 1. One patient (NC) had limited disease (Ann Arbor stage IIE) and the other (EA) stage IV disease. After diagnostic orchiectomy, patients received CHOP plus either IT ARA-C (60 mg on day 1) and high-dose MTX (3000 mg/mq as a 6-hour i.v. infusion with leucovorin rescue on day 2) at cycles 1, 3, 5, or IT MTX (15 mg on day 1) and intermediate-high dose ARA-C (2000 mg/mq/12 hours as a 2-hour i.v. infusion on day 2; total dose per cycle 4000 mg/mq). G-CSF 5 mg/kg was administered on days 7-12 of each course. Six courses of chemotherapy were planned at 3-week intervals, provided at least partial remission was documented after the fourth cycle. No course was delayed because of toxicity and there was no treatment-related hospitalization. We did not observe grade 3-4 neutropenia and no patient required platelet or red blood transfusions. No severe cardiac, renal, hepatic, gastrointestinal, cerebellar, or pulmonary toxicity was documented. No febrile episode was observed during the treatment. Both patients achieved complete remission after chemotherapy. Consolidation therapy consisted in RT to the scrotum, controlateral testis and retroperitoneal lymph nodes for the patient with limited disease and in RT to the retroperitoneum and Waldeyer's ring followed by myeloablative chemotherapy with stem cell support in the other one. After 2 years of follow-up both patients are alive and disease-free. Based on these preliminary data, this schedule appears promising for testicular NHL. However, the potential benefit should be confirmed with longer follow-up in a larger population, if patients.
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