Reactions 1680, p40 - 2 Dec 2017 Epstein-Barr virus related primary diffuse large B- cell lymphoma of the central nervous system: case report A 66-year-old man developed Epstein-Barr virus (EBV) related primary diffuse large B-cell lymphoma of the central nervous system (CNS DLBCL) after chemotherapy with doxorubicin, vincristine, cyclophosphamide, prednisone, etoposide, cytarabine and dexamethasone [time to reaction onsets and routes not stated; not all outcomes stated]. The man was diagnosed with CCR4-positive peripheral T- cell lymphoma, not otherwise specified (PTCL-NOS). He received CHOP chemotherapy including doxorubicin 2 2 50 mg/m , vincristine 1.4 mg/m and cyclophosphamide 2 2 750 mg/m on day 1; prednisone 60 mg/m on days 1-5 and CHASE chemotherapy including etoposide 100 mg/m on days 1-3; cyclophosphamide 1,200 mg/m on day 1; cytarabine 1,000 mg/m on days 2 and 3 and dexamethasone 40 mg/body on days 1-3. Since the CHOP and CHASE chemotherapies were ineffective, he then received mogamulizumab therapy each week. After 7 cycles of the mogamulizumab therapy, he developed paralysis of right upper limb. Brain MRI revealed multiple brain tumors with ring enhancement. CSF examination showed EBV-DNA without abnormal cells. A brain biopsy showed bleeding, oedema and destruction as well as infiltration by abnormal small circular cells around the blood vessels of the brain parenchyma. These abnormal cells expressed L26, but not CD3 and CD5; however, PTCL cells were positive for CD3 and CD5 before the chemotherapies. In situ hybridisation of these cells revealed positivity for EBV-encoded small RNA. Based on these findings, a diagnosis of EBV-related CNS DLBCL as a secondary malignancy was made. A review of previously performed axial lymph node biopsy showed EBV-encoded small RNA positivity for CD20-positive B-lymphocytes around the PTCL cells. The man received palliative treatment. Eventually, 4 months after the diagnosis of PTCL-NOS, he died while comatose [cause of death not stated]. Author comment: "We cannot exclude the possibility that severe immunosuppression due to [peripheral T-cell lymphoma, not otherwise specified] itself and the previous chemotherapies already existed before mogamulizumab treatment and resulted in the development of the [Epstein- Barr virus (EBV) related primary diffuse large B-cell lymphoma of the central nervous system]." Tanaka H, et al. Development of epstein-barr virus-related primary diffuse large B- cell lymphoma of the central nervous system in a patient with peripheral T-cell lymphoma, not otherwise specified after mogamulizumab treatment. Internal Medicine 56: 2759-2763, No. 20, Jan 2017. Available from: URL: http:// doi.org/10.2169/internalmedicine.8781-16 - Japan 803284153 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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