Department of Hematology, Shinko Hospital, Kobe, Japan.
Department of Pathology, Shinko Hospital, Kobe, Japan.
J Clin Exp Hematop. 2024 Mar 28;64(1):32-36. doi: 10.3960/jslrt.23039. Epub 2024 Feb 28.
Primary testicular lymphoma (PTL) frequently relapses in the central nervous system (CNS) despite prophylactic intrathecal chemotherapy, and the outcome for CNS recurrence of PTL is very poor. We report a case of isolated CNS recurrence of bilateral PTL. Our patient achieved complete response (CR) after rituximab-combination chemotherapy for PTL. Approximately five years later, isolated CNS recurrence of PTL occurred. Our patient achieved CR again after high-dose methotrexate therapy and autologous stem cell transplantation (ASCT) with a conditioning regimen of thiotepa and busulfan as a consolidation therapy. The secondary failure of platelet recovery, probably caused by busulfan, occurred after the platelet engraftment. Our patient has remained in CR for over three years. The treatment strategy for CNS recurrence of PTL is mainly whole-brain radiotherapy or high-dose methotrexate-based chemotherapy; however, CNS recurrence of PTL may occur again even after achieving CR. ASCT with a conditioning regimen of thiotepa and busulfan is the optimal consolidation therapy for secondary CNS lymphoma. To the best of our knowledge, this is the second reported case of a patient with isolated CNS recurrence of PTL successfully treated by ASCT with a conditioning regimen of thiotepa and busulfan as a consolidation therapy.
原发性睾丸淋巴瘤（PTL）尽管进行了预防性鞘内化疗，但仍经常在中枢神经系统（CNS）复发，PTL 中枢神经系统复发的预后非常差。我们报告了一例双侧 PTL 孤立性中枢神经系统复发的病例。我们的患者在接受利妥昔单抗联合化疗治疗 PTL 后达到完全缓解（CR）。大约五年后，PTL 出现孤立性中枢神经系统复发。我们的患者在高剂量甲氨蝶呤治疗和以噻替哌和白消安为巩固治疗的自体干细胞移植（ASCT）后再次达到 CR。血小板植入后，可能由于白消安导致血小板恢复的二次失败。我们的患者已持续 CR 超过三年。PTL 中枢神经系统复发的治疗策略主要是全脑放疗或大剂量甲氨蝶呤为基础的化疗；然而，即使达到 CR，PTL 中枢神经系统复发仍可能再次发生。以噻替哌和白消安为巩固治疗的 ASCT 是治疗继发性中枢神经系统淋巴瘤的最佳巩固治疗。据我们所知，这是第二例成功接受以噻替哌和白消安为巩固治疗的 ASCT 治疗的孤立性 PTL 中枢神经系统复发的患者报道。
