Villafranca Jose Javier Arenas, Siles Marga Garrido, Casanova María, Goitia Begoña Tortajada, Domínguez Antonio Rueda
Pharmacy and Nutrition Service, Costa del Sol Hospital, Autovía A7, km187, CP, 29603, Marbella, Málaga, Spain.
J Med Case Rep. 2014 Sep 8;8:300. doi: 10.1186/1752-1947-8-300.
Paraneoplastic pruritus is defined as pruritus that occurs before or during the natural evolution of a hematologic disease. The reported prevalence is 30% in patients with Hodgkin's lymphoma. The severity of this pruritus has a very negative impact on patients' quality of life. Very few studies have been made to examine the efficacy of pharmacological treatments for this type of pruritus. One drug that appears to be effective in this respect is off-label aprepitant, a neurokinin 1 receptor antagonist.
A 20-year-old Caucasian woman presented with lateral neck nodes, sweating, and pruritus and was diagnosed with stage IIB nodular sclerosis Hodgkin's lymphoma. Throughout this period during the disease the pruritus was ever-present. Improvement was achieved with some of the chemotherapy treatments, but the symptom returned when the various treatments were withdrawn due to disease progression or poor tolerance. In the middle of the seventh year, she was admitted to our hospital with uncontrolled pruritus that resulted in severe lesions due to scratching. In response, aprepitant (off-label) 80 mg/day was added to the chemotherapic treatment of the pruritus, after studying the various treatment options. She reported a score of 9 on a visual analogue scale for the pruritus, and a score of 3 on the Eastern Cooperative Oncology Group performance status scale of performance status. After two weeks of treatment with aprepitant, she reported a score of 5 on the visual analogue scale for the pruritus, and this improved to a score of 4 in a month, which allowed her to lead a better quality of life, with an Eastern Cooperative Oncology Group performance status score between 1 and 2.
Several cases and case series have been reported on the use of aprepitant for paraneoplastic pruritus, but none have referred to its use for Hodgkin's lymphoma. A prospective study was carried out to evaluate the efficacy of this drug in refractory pruritus secondary to Sezary syndrome, and other authors have studied the effectiveness of aprepitant against pruritus, secondary to biological therapy with erlotinib. In our case report, treatment was started with daily doses of aprepitant 80 mg. Pruritus improvement appeared to be attributable exclusively to the administration of aprepitant.
副肿瘤性瘙痒被定义为在血液系统疾病自然发展之前或期间出现的瘙痒。据报道，霍奇金淋巴瘤患者中该瘙痒的患病率为30%。这种瘙痒的严重程度对患者的生活质量有非常负面的影响。针对这类瘙痒的药物治疗效果的研究非常少。在这方面似乎有效的一种药物是阿瑞匹坦（未按药品说明书用药），一种神经激肽1受体拮抗剂。
一名20岁的白种女性出现颈部外侧淋巴结肿大、出汗和瘙痒症状，被诊断为IIB期结节硬化型霍奇金淋巴瘤。在疾病的整个病程中，瘙痒一直存在。一些化疗治疗取得了改善，但由于疾病进展或耐受性差而停止各种治疗时，症状又复发了。在第七年中期，她因瘙痒无法控制且因搔抓导致严重皮损而入住我院。在研究了各种治疗方案后，在针对瘙痒的化疗治疗中加用了阿瑞匹坦（未按药品说明书用药）80毫克/天。她在瘙痒视觉模拟量表上的评分为9分，东部肿瘤协作组体能状态量表评分为3分。用阿瑞匹坦治疗两周后，她在瘙痒视觉模拟量表上的评分为5分，一个月后改善至4分，这使她能够过上质量更好的生活，东部肿瘤协作组体能状态评分在1至2分之间。
已有几例病例和病例系列报道了使用阿瑞匹坦治疗副肿瘤性瘙痒，但均未提及用于霍奇金淋巴瘤。一项前瞻性研究评估了该药对塞扎里综合征继发难治性瘙痒的疗效，其他作者研究了阿瑞匹坦对厄洛替尼生物治疗继发瘙痒的有效性。在我们的病例报告中，开始每日服用80毫克阿瑞匹坦进行治疗。瘙痒的改善似乎完全归因于阿瑞匹坦的使用。
