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Prof. Dr. med. R. Herrmann Medical Oncology University Hospital Petersgraben 4 CH-4031 Basel Lymphoma Cases
Patient: 56 y, manager 02/93 endonasal sinus revision resection of a nasopharyngeal tumor centroblastic lymphoma (DLBCL), ...
08/08 Patient is now 72 years old aortocoronary artery bypass surgery incidental finding of mediastinal lymph nodes Hist: ...
CT-scan 02/09 Case 1
02-06/09 4 x R-CHOP +  2 x R-COEP  (doxorubicin replaced by etoposide due to      cumulative dose) 2 x R 04/09 CT-scan: pa...
CT-scan 04/09 Case 1
02-06/09 4 x R-CHOP +  2 x R-COEP  (doxorubicin replaced by etoposide due to      cumulative dose) 2 x R 04/09 CT-scan: pa...
CT-scan 12/10 Case 1
12/10-03/11 4 x R-Bendamustine 02/11 CT-scan: significant size regression, e. g.  iliacal 4,8 x 11,8 cm Case 1
CT-scan 02/11 Case 1
12/10-03/11 4 x R-Ribomustine 02/11 CT-scan: significant size regression, e. g.  iliacal 4,8 x 11,8 cm planned:  another 2...
Patient: 56 y asymptomatic 02/99 cervical lymphadenopathy,  lymph node biopsy left neck hist:  follicular lymphoma II° sit...
05/01 CT-scan: progression of intraabdominal lymph nodes what next? 05 – 10/01 chlorambucil and prednisone    significant...
CT-scan 04/08 Case 2
Follow-up every 6 months 10/08 clinical examination and abdominal ultrasound:  stable disease 02/11 clinical examination a...
Case 2 abd.US 02/11
Follow-up every 6 months 10/08 clinical examination and abdominal ultrasound:  stable disease 02/11 clinical examination a...
Patient: 46 y  journalist 06/02 severe pancytopenia (hgb 70, wbc 2.2, plt 35), fever CT-scan:  multiple lymph nodes medias...
07 – 12/02 8 x BEA-COPP esc. (HD-12) 12/02 PET:    complete remission 02 – 03/03 radiotherapy at previous bulks: mediasti...
Patient: 79  y , former manager of chemical industry history of coronary artery disease 12/06 left axillary lymphadenopath...
CT-scan 12/06 Case 4
12/06 left axillary lymphadenopathy CT-scan: multiple lymph nodes axillary (left: 5 x 7 x 3 cm),    retroperitoneal, mesen...
CT-scan 03/07 Case 4
31.05.07 diplopia, mydriasis, ptosis, left temporo-orbital pain  06/07 clinical examination: oculomotor nerve palsy, posit...
06 – 08/07 5 x liposomal cytarabine  i. th. (q 14d)     complete regression of neurological symptoms within 2 w. ~ 10/07 ...
PET 02/08 2 h after 185 MBq  111 In-Zevalin injection 3 d after 185 MBq  111 In-Zevalin injection Case 4
06 – 08/07 5 x liposomal cytarabine  i. th. (q 14d)     complete regression of neurological symptoms within 2 w. ~ 10/07 ...
05-11/08 6 x Vincristine/Bleomycin/Prednisone (d1-5) GOMEZ regimen as needed    good response 12/08 percutaneous radiothe...
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LLA 2011 - R. Hermann - Diagnosis and therapy in lymphoma: Case presentations

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LLA 2011 - R. Hermann - Diagnosis and therapy in lymphoma: Case presentations

  1. 1. Prof. Dr. med. R. Herrmann Medical Oncology University Hospital Petersgraben 4 CH-4031 Basel Lymphoma Cases
  2. 2. Patient: 56 y, manager 02/93 endonasal sinus revision resection of a nasopharyngeal tumor centroblastic lymphoma (DLBCL), stage II E sites: epipharynx + cervical lymph nodes treatment 03 – 06/93 6 x CHOP  significant regression CR 08 – 08/93 30 Gy RT of epipharynx region  regular follow-up, persisting xerostomia Case 1 Case 1
  3. 3. 08/08 Patient is now 72 years old aortocoronary artery bypass surgery incidental finding of mediastinal lymph nodes Hist: infiltration by a small cell lymphoma IHC: CD20+; CD79a+; bcl-2+; CD10-; CD5-; Cyclin 1- proliferation-index: < 20% D: marginal zone lymphoma St.: III A E , asymptomatic watch & wait 02/09 symptomatic, impaired swallowing CT-scan: mass lateral pharynx, cervical, mediastinal, axillary retroperitoneal and iliac lymph nodes what kind of treatment? Case 1
  4. 4. CT-scan 02/09 Case 1
  5. 5. 02-06/09 4 x R-CHOP + 2 x R-COEP (doxorubicin replaced by etoposide due to cumulative dose) 2 x R 04/09 CT-scan: partial remission Case 1
  6. 6. CT-scan 04/09 Case 1
  7. 7. 02-06/09 4 x R-CHOP + 2 x R-COEP (doxorubicin replaced by etoposide due to cumulative dose) 2 x R 04/09 CT-scan: partial remission 06/09 CT-scan: partial remission 12/10 CT-scan: multiple supraclavicular, infraclavicular, mediastinal, infracarinal ( ø 2,6 x 1,5 cm), axillary (ø 2,3 x 1,0 cm), mesenteric, iliac lymph nodes with bulky disease (ø 12,5 x 7,2 cm) Case 1
  8. 8. CT-scan 12/10 Case 1
  9. 9. 12/10-03/11 4 x R-Bendamustine 02/11 CT-scan: significant size regression, e. g. iliacal 4,8 x 11,8 cm Case 1
  10. 10. CT-scan 02/11 Case 1
  11. 11. 12/10-03/11 4 x R-Ribomustine 02/11 CT-scan: significant size regression, e. g. iliacal 4,8 x 11,8 cm planned: another 2 cycles of chemotherapy Case 1
  12. 12. Patient: 56 y asymptomatic 02/99 cervical lymphadenopathy, lymph node biopsy left neck hist: follicular lymphoma II° sites: cervical, paraaortal LN, bone marrow stage: IV A management? no immediate treatment 09/99 growing cervical nodes 10/99 – 03/00 chemotherapy with chlorambucil and prednisone  significant regression (PR) 04/01 progression of peripheral lymph nodes what next? Case 2 Case 2
  13. 13. 05/01 CT-scan: progression of intraabdominal lymph nodes what next? 05 – 10/01 chlorambucil and prednisone  significant regression 11/02 rapidly progressing inguinal LN CT-scan: multiple mediastinal and abdominal lymph nodes  progressive disease what next? 11/02 – 03/03 6 x R-CHOP  significant regression (CR) regular follow up 04/08 unspecific abdominal symptoms clinical examination: right supraclavicular lymph node ( ø 1cm) CT-scan: multiple lymph nodes: cervical, axillary, mesenterial (ø 1,8 cm), retroperitoneal, pelvic, inguinal Case 2
  14. 14. CT-scan 04/08 Case 2
  15. 15. Follow-up every 6 months 10/08 clinical examination and abdominal ultrasound: stable disease 02/11 clinical examination and abdominal ultrasound: stable disease Case 2
  16. 16. Case 2 abd.US 02/11
  17. 17. Follow-up every 6 months 10/08 clinical examination and abdominal ultrasound: stable disease 02/11 clinical examination and abdominal ultrasound: stable disease watch & wait Case 2
  18. 18. Patient: 46 y journalist 06/02 severe pancytopenia (hgb 70, wbc 2.2, plt 35), fever CT-scan: multiple lymph nodes mediastinal, axillary, retro- peritoneal, subhepatic with infiltration of portal structures BM-biopsy: granulomatous involvement by Hodgkin lymphoma CT-guided biopsy of subhepatic mass Hist: classical Hodgkin lymphoma IHC: CD30+; CD15+ St.: IVB Case 3 Case 3
  19. 19. 07 – 12/02 8 x BEA-COPP esc. (HD-12) 12/02 PET:  complete remission 02 – 03/03 radiotherapy at previous bulks: mediastinal, hilar, epigastrium (total dose: 30 Gy) regular follow-up continuous CR 01/11 unspecific abdominal symptoms colonoscopy: cancer of the transverse colon CT scan: multiple liver metastases laparotomy: multiple peritoneal seedings Case 3
  20. 20. Patient: 79 y , former manager of chemical industry history of coronary artery disease 12/06 left axillary lymphadenopathy CT-scan: multiple lymph nodes axillary (left: 5 x 7 x 3 cm), retroperitoneal, mesenterial. Splenomegaly. Case 4 Case 4
  21. 21. CT-scan 12/06 Case 4
  22. 22. 12/06 left axillary lymphadenopathy CT-scan: multiple lymph nodes axillary (left: 5 x 7 x 3 cm), retroperitoneal, mesenterial. Splenomegaly. 01/07 lymph node biopsy Hist: diffuse large B-cell lymphoma (DLBCL) IHC: CD20+; CD5-, MIB-1: 80-90% BM-b x : 5-8% infiltration by DLBCL which treatment? 01 – 04/07 6 x R-CHOP-14 + 2 x R  complete remission Case 4
  23. 23. CT-scan 03/07 Case 4
  24. 24. 31.05.07 diplopia, mydriasis, ptosis, left temporo-orbital pain 06/07 clinical examination: oculomotor nerve palsy, positive Babinski, muscle weakness right quadriceps cMRI: isolated contrast enhancement and thickening in the left oculomotor nerve CT-scan: no extracranial progression lumbar puncture: Lc 10G/l protein: 1029 mg/l FACS: monoclonal B cells, CD19+; lambda light chain restriction  D: lymphomatous meningitis Case 4
  25. 25. 06 – 08/07 5 x liposomal cytarabine i. th. (q 14d)  complete regression of neurological symptoms within 2 w. ~ 10/07 maintenance therapy with i.th. liposomal cytarabine(q 28d) 02/08 extensive systemic recurrence: multiple right cervical lymph nodes (ø 7 cm) 2 nd line treatment with R-gemcitabine + Y90-ibritumumab-tiutexan (clinical trial)  complete remission Case 4
  26. 26. PET 02/08 2 h after 185 MBq 111 In-Zevalin injection 3 d after 185 MBq 111 In-Zevalin injection Case 4
  27. 27. 06 – 08/07 5 x liposomal cytarabine i. th. (q 14d)  complete regression of neurological symptoms within 2 w. ~ 10/07 maintenance therapy with liposomal cytarabine (q 28d) 02/08 extensive recurrence: multiple right cervical lymph nodes (ø 7 cm) 2nd line treatment with R-gemcitabine + Y90-ibritummab-tiutexan (clinical trial)  complete remission 03/08 local recurrence: multiple right cervical lymph nodes  R-gemcitabine  discontinuation due to myelotoxicity and lack of response Case 4
  28. 28. 05-11/08 6 x Vincristine/Bleomycin/Prednisone (d1-5) GOMEZ regimen as needed  good response 12/08 percutaneous radiotherapy right neck (total dose: 40,5 Gy) 01/09 dyspnea, orthopnea CT-scan: progressive disease in lung, mediastinum and abdomen  exitus letalis Case 4

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