Erschienen in:
01.06.2009 | Original Article
Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition
verfasst von:
Yasufumi Masaki, Lingli Dong, Akio Nakajima, Haruka Iwao, Miyuki Miki, Nozomu Kurose, Eriko Kinoshita, Takayuki Nojima, Toshioki Sawaki, Takafumi Kawanami, Masao Tanaka, Kumiko Shimoyama, Changi Kim, Masaaki Fukutoku, Hiroshi Kawabata, Toshihiro Fukushima, Yuko Hirose, Tomoo Takiguchi, Susumu Konda, Susumu Sugai, Hisanori Umehara
Erschienen in:
International Journal of Hematology
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Ausgabe 5/2009
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Abstract
We summarize our experience and propose methods for early diagnosis and treatment of intravascular large B cell lymphoma (IVL). A total of 16 patients with IVL between 1994 and 2007 were included and analyzed in this study. Predicted survival durations were short until September 2003. However, there have been marked improvement since the introduction of rituximab, and all patients responded to treatment and survived for more than 1 year following diagnosis of IVL. We propose an early clinical diagnostic strategy for starting treatment for IVL patients with quite poor performance status (PS) and in whom time is a limiting factor: (1) age >40 years, (2) fever above 38°C with poor PS (ECOG 2-4), (3) lactate dehydrogenase (LDH) more than twice the upper limit of the normal level and/or sIL2R >5,000 IU/ml in serum, (4) worsening PS and/or elevation of serum LDH on a daily basis, and (5) confirmation of pathological lymphoid cells in peripheral blood or bone marrow smear and/or flow cytometry. Although accurate pathological diagnosis is quite important, time is a limiting factor for most of IVL patients. In such cases, we can start chemotherapy based on early clinical diagnostic strategy with high sensitivity and obtain good clinical outcome.