Kama Kudret, La Rosée Paul, Czock David, Bosch-Schips Jan, Illerhaus Gerald
Department of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, DEU.
Clinic for Internal Medicine II, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, DEU.
Cureus. 2022 Jun 12;14(6):e25885. doi: 10.7759/cureus.25885. eCollection 2022 Jun.
Due to the low incidence and the large number of postmortem diagnoses, treatment recommendations for intravascular large B-cell lymphoma (IVLBCL) are largely based on retrospective studies and case reports. There is little data on autologous stem cell transplantation (ASCT) in dialysis-dependent patients and choosing an adequate regimen and dosing is difficult. Here, we report the treatment of a patient with relapsed IVLBCL and end-stage renal disease caused by lymphoma-associated renal AA amyloidosis using a modified TEAM (thiotepa, etoposide, cytarabine, and melphalan) regimen and ASCT. A 42-year-old female had an early relapse of hemophagocytic syndrome-associated intravascular large B-cell lymphoma resulting in terminal renal disease with dialysis dependency. Because of comorbidities (AA amyloidosis with severe hypoalbuminemia and end-stage renal disease), a modified, dose-reduced TEAM regimen was used as a high-dose conditioning regimen based on clinical pharmacologic considerations. The patient developed grade three mucositis and grade four febrile neutropenia as adverse events after transplantation. A modified TEAM regimen is feasible in a patient with end-stage renal disease with manageable toxicity. This is the first report of treatment with thiotepa in a dialysis-dependent patient.
由于血管内大B细胞淋巴瘤（IVLBCL）发病率低且大量为尸检诊断，其治疗建议主要基于回顾性研究和病例报告。关于依赖透析患者的自体干细胞移植（ASCT）的数据很少，且难以选择合适的方案和剂量。在此，我们报告了1例复发性IVLBCL并伴有淋巴瘤相关肾AA淀粉样变性所致终末期肾病患者，采用改良的TEAM（噻替派、依托泊苷、阿糖胞苷和美法仑）方案及ASCT进行治疗的情况。1例42岁女性患者，噬血细胞综合征相关的血管内大B细胞淋巴瘤早期复发，导致终末期肾病并依赖透析。由于存在合并症（AA淀粉样变性伴严重低白蛋白血症和终末期肾病），基于临床药理学考虑，采用改良的、剂量降低的TEAM方案作为大剂量预处理方案。患者移植后出现3级黏膜炎和4级发热性中性粒细胞减少等不良事件。改良的TEAM方案在伴有可管理毒性的终末期肾病患者中是可行的。这是关于噻替派用于依赖透析患者治疗的首例报告。
