Methotrexate, Hydrocortisone, Vincristine, Sobuzoxane, and Etoposide Is an Effective Option for Relapsed T-cell Prolymphocytic Leukemia with Loss of CD52 Expression after Retreatment with Alemtuzumab

Article

作者: Suzuki, Manabu ; Ohta, Masatsugu ; Sukegawa, Masumi ; Ikeda, Shohei ; Tsunoda, Saburo

T-cell prolymphocytic leukemia (T-PLL) is a rare and highly aggressive mature T-cell neoplasm. Although the response rate to alemtuzumab, an anti-CD52 antibody, is high, it is difficult to cure the disease with this agent alone. Therefore, hematopoietic stem cell transplantation is recommended for eligible patients. However, there are few effective salvage therapy options for patients ineligible for hematopoietic stem cell transplantation. In this study, we report the case of an elderly patient with relapsed or refractory T-PLL who underwent salvage therapy with methotrexate, hydrocortisone, vincristine, sobuzoxane, and etoposide (MTX-HOPE). The patient was an 85-year-old man. He was administered alemtuzumab twice (at the time of initial treatment and relapse) and cyclophosphamide, vincristine, and hydrocortisone chemotherapy. Furthermore, novel therapeutic drugs (venetoclax and tofacitinib) were administered based on previous case reports. However, the patient was resistant to all treatments, and the tumor cells lost CD52 expression. We administered MTX-HOPE, and the patient survived for approximately 8 months. Although red blood transfusions were necessary because of disease progression, no adverse events were observed because of treatment, and the patient was able to maintain activities of daily living until immediately before death. MTX-HOPE is a combination of classical chemotherapy agents originally developed for palliative chemotherapy in frail patients with refractory lymphoma. MTX-HOPE has been reported to be effective against T-cell tumors. Severe nonhematologic adverse events are rarely reported; however, bone marrow suppression is commonly observed. Grade 3-4 neutropenia has been documented in approximately half of the patients. Therefore, patients should be closely monitored, particularly at the onset of therapy. Consideration should be given to suspending treatment, adjusting the administration interval, or administering G-CSF if necessary. The treatment interval can be appropriately adjusted, making it a valuable treatment option for refractory T-PLL.

2022-01-01·Dermatology4区 · 医学

Low-Dose MST-16/VP-16 Combination Chemotherapy in 9 Patients with Tumor Stage Mycosis Fungoides

4区 · 医学

Article

作者: Nagatani, Tetsuo ; Umebayashi, Yosihiro ; Irisawa, Ryokichi ; Tsuboi, Ryoji ; Kato, Yukihiko ; Harada, Kazutoshi ; Mae, Ken-Ichiro ; Kanzaki, Ayano ; Fukuhara, Yui

Background/Aim: MST-16 and VP-16, both of which are topoisomerase II inhibitors, are antitumor agents regularly used to treat malignant lymphoma and small cell lung carcinoma. New therapeutic agents for tumor stage mycosis fungoides (MF) have recently been developed, but their efficacy is limited. We herein retrospectively reported the use of MST-16/VP-16 combination therapy for tumor stage MF at multiple treatment centers and examined their antitumor effect. Methods: Five male and four female patients with tumor stage MF were enrolled. Age at the start of therapy ranged from 33 to 80 years (average: 54.5 years), and the previous treatment consisted of R-CHOP, CAVOP-IFN, etc. The protocol for low-dose MST-16/VP-16 combination chemotherapy consisted of 800 mg MST-16 and 25 mg VP-16 administered 5 days per month. Results: Three of the 9 patients died, but two of the three fatalities were unrelated to MF. A treatment effect was seen in three and 6 patients who showed a complete response and a partial response, respectively. The 5-year and 10-year overall survival rate was 85.7% and 57.1%, respectively. Adverse reactions consisted of 4 cases of nausea and 1 case of leukopenia. Conclusion: The present study demonstrated that the response rate to MST-16/VP-16 combination therapy was 100% and that the treatment effect was relatively long, suggesting that this therapy may be a viable option for treating tumor stage MF.

2021-07-03·Expert Review of Anticancer Therapy3区 · 医学

Clinical feasibility of oral low-dose etoposide and sobuzoxane for conventional chemotherapy–intolerant lymphoma patients

3区 · 医学

Article

作者: Ohmoto, Akihiro ; Fuji, Shigeo

Introduction: In Japan, etoposide or sobuzoxane, a type of topoisomerase II inhibitor, is orally administered in patients with lymphoma who cannot tolerate conventional combination chemotherapy. However, the related clinical data remain to be fully summarized.Areas covered: We evaluate the efficacy and toxicity of etoposide and sobuzoxane.Expert opinion: Previous studies on etoposide or sobuzoxane monotherapy, including those among patients who could not tolerate conventional chemotherapy, suggested a favorable overall response rate (ORR) with moderate gastrointestinal or liver/renal toxicity. As for adult T-cell leukemia/lymphoma, a clinical trial with a limited sample size exhibited an ORR of >70%. Remarkably, the percentage of patients with a poor performance status was high among those receiving etoposide/sobuzoxane. Given a lack of randomized studies, etoposide/sobuzoxane might be a therapeutic option for lymphoma in a palliative setting. In the future, prospective trials with a homologous treatment schedule are warranted, in which the association between clinical efficacy and characteristics of lymphomas, such as specific gene alterations, should be elucidated.

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