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• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11952

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    P2.24-006 - Bronchial associated lymphoid tissue (BALT) lymphoma - Is Rituximab alone a viable option instead of aggressive local therapy and high dose chemotherapy even in the relapsed setting for this rather rare entity? (ID 711)

    09:30 - 09:30  |  Author(s): D. Chi
    • Abstract

    Background
    BALT Lymphoma accounts for only 1% of Non Hodgkin’s Lymphoma leading to the paucity of randomized clinical trials to outline the treatment options (1). There are a few recently published case reports in the literature claiming success with single agent rituximab therapy but none in the relapsed setting with repeat rituximab treatment.

    Methods
    A 67-year-old woman was initially diagnosed with BALT lymphoma involving the left lower lobe 10 years prior, for which she underwent wedge resection alone. Five years later, she developed recurrence with multiple bilateral lung nodules noted on her annual CT scan. She was then treated with chemotherapy using Rituximab, cyclophosphamide, vincristine and prednisone given for 12 cycles. She achieved completed remission. Her annual surveillance CT scan four years later showed a left lower lobe lesion. Staging PET/CT scan showed isolated uptake in the left lower lobe lesion with SUV of 4.7 with no evidence of disease elsewhere. The biopsy showed recurrent BALT lymphoma. Immunostains were positive for CD20 and CD79a. Bone marrow biopsy showed no evidence of lymphoma. She was then treated with four weekly doses of Rituximab at 375mg/m2. Follow up CT scan after completion of the treatment showed complete resolution of the left lower lobe lesion. She was started on maintenance treatment with Rituximab to be given every 3 months.

    Results
    There are no set guidelines for treatment of BALT lymphoma but general consensus has been local therapy with either surgery or radiation for early stage disease, and chemotherapy for late stages. Also resection might not possible for patients with poor lung function (1). A phase II study of monoclonal antibody rituximab showed overall response rate of 73% (2). Several case reports also suggested completed remission (CR) with 4 to 8 weekly doses of rituximab (3). However, high relapse rate of 36% , observed in a phase II study (2) suggests that perhaps the 4-weekly-doses regimen may not represent the best schedule. Recent meta-analysis showed improvement in the overall survival with maintenance rituximab treatment in the relapsed setting in patients with follicular lymphoma (4). Given that BALT lymphoma is a subtype of Non-Hodkins Lymphoma, we extrapolated the data to our patient and started her on maintenance treatment.

    Conclusion
    Although longer follow-up is needed in our case, the demonstration of minimal toxicity and considerable activity of this biologic agent in the relapsed setting is promising. 1. Ferraro P et al. Primary non-Hodgkin’s lymphoma of the lung. Ann Thorac Surg 2000;69: 993-7. 2. Conconi A et al. Clinical activity of rituximab in extranodal marginal zone B-cell lymphoma of MALT type. Blood 2003;102: 2741-5 3. Ahmet Bilici et al. Pulmonary BALT lymphoma successfully treated with eight cycles of weekly Rituximab: Report of first case and F-18 FDG PET/CT Images. J Korean Med Sci. 2011 April; 26(4): 574–576. 4. Vidal L et al. Rituximab maintenance for the treatment of patients with follicular lymphoma: an updated systematic review and meta-analysis of randomized trials. J Natl Cancer Inst. 2011 Dec 7;103(23):1799-806.