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Thalidomide therapy induces response in relapsed mantle cell lymphoma

Leukemia volume 17, pages 1914–1915 (2003)Cite this article

Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma that cannot be cured despite aggressive therapy, including autologous stem cell transplantation. Thalidomide is an immunomodulatory drug with numerous properties that has proven effective in relapsed multiple myeloma and, to a lesser extent, in other hematological diseases, such as myelodysplastic syndromes and myeloproliferative disorders. We report two cases of relapsed refractory MCL successfully treated with thalidomide.

The first patient is a 70-year-old man, who presented in 1995 with stage IV MCL. He was treated according to the current protocol at our institution, as reported elsewhere.1 He received CHOP × four cycles with only a partial response (PR), followed by high-dose cytarabine-based chemotherapy (DHAP), and consolidation with an autologous stem cell transplant utilizing total body irradiation (TBI), melphalan, and cytarabine as the preparative regimen. A complete response (CR) was obtained. The patient relapsed 40 months later, presenting with diffuse peripheral and abdominal lymphadenopathy, splenomegaly, bone marrow and peripheral blood involvement, and a lactate dehydrogenase (LDH) level twice the normal. As salvage chemotherapy, the patient received concurrent cytarabine (2 g/m2/12 h, days 1–3) and etoposide (200 mg/m2/day, days 1–3). After a transient response, the patient progressed 3 weeks after the third cycle. The patient next received two cycles of concurrent fludarabine (30 mg/m2/day, days 1–3) and cyclophosphamide (300 mg/m2/day, days 1–3), and obtained PR. Treatment was complicated by persistent grade 4 pancytopenia (ANC <0.1 × 109/l) and infection. As a consequence, the patient declined further chemotherapy. After 4 months, when the patient's peripheral lymphadenopathy increased, he received a 4-week course of rituximab (375 mg/m2 per week) without any response. In June 2001, the patient developed worsening pancytopenia and compressive iliac lymphadenopathy and started thalidomide at 200 mg/day, increasing by 100 mg/day every 2 weeks, up to 500 mg/day. Hematopoiesis and lymphadenopathy progressively improved, with the patient becoming transfusion independent within 2 months of beginning thalidomide. By the 4th month, the hemoglobin and platelet levels had reached 12 g/dl and 176 × 109/l, respectively, with a complete disappearance of peripheral blood atypical lymphocytes and a 50% reduction in the size of the lymphadenopathy. Over the next year, the patient maintained his response on 300 mg/day of thalidomide. Although the patient was tolerating the thalidomide, the dose was decreased to 200 mg/day for 2 weeks each month, to decrease the risk of chronic thalidomide side effects. After 4 months (September 2002), the patient's disease progressed, with reappearance of the pancytopenia and increased lymphadenopathy. A bone marrow examination was not performed. Thalidomide was increased to 200 mg each day in combination with three courses of monthly dexamethasone (40 mg/day × 4 days), reachieving a partial response. At 19 months since first starting thalidomide, the patient remains alive and with a good partial response.

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  1. G Damaj

    Present address: Institut Paoli, Calmettes, 232 Blvd sainte Marguerite, 13273, cedex 9, Marseille, France

Authors and Affiliations

  1. Department of Hematology, Hôpital Necker Enfants-Malades, Paris, France

    G Damaj, F Lefrère, R Delarue, B Varet & O Hermine

  2. Department of Hematology, Mount Sinai School of Medicine, NY, USA

    R Furman

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Damaj, G., Lefrère, F., Delarue, R. et al. Thalidomide therapy induces response in relapsed mantle cell lymphoma. Leukemia 17, 1914–1915 (2003). https://doi.org/10.1038/sj.leu.2403058

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