ABCL-290 Primary Central Nervous System Diffuse Large B-Cell Lymphoma: Case Presentation

Abstract

Primary central nervous system diffuse large B-cell lymphoma (PCNSL) is an ominous disease with a poor prognosis. PCNSL is now known to be a form of extra-nodal, high-grade non-Hodgkin B-cell neoplasm, usually large cell or immunoblastic type. Sharing a rare case report of PCNSL and its diagnostic and therapeutic outcome. A case report. A 46-year-old woman was admitted in our clinic with a persistent frontal headache associated with dizziness, fatigue, and weakness. Brain MRI revealed a right frontal ganglia lesion, and a biopsy was performed on the site. The HP/Dg showed a right frontal lesion - diffuse large B-cell lymphoma, positive on CD20 with Ki-67: 90%. Since laboratory tests and physical examination findings were normal, we decided to immediately start treating our patient with rituximab-temozolomide protocol. After 6 rounds of chemotherapy, we repeated a brain MRI, and it revealed no pathological findings other than scars after the first surgery. Then, we decided to perform a PET-CT, which also revealed no pathological FDG absorption in the brain but two hypermetabolic zones in the liver with SUV-7.2. The following abdomen MRI revealed no pathological lesions in the liver, so we decided to continue with maintenance therapy with temozolomide for 8 months. Unfortunately, during the sixth round of maintenance therapy, the patient developed headaches, and repeated brain MRI revealed 35×30-mm lesions on the parasagittal frontal left hemisphere. We decided to treat with RMPV protocol. After 6 cycles of RMVP, a brain MRI revealed regression of lesions in both sides of frontal lobe, and the patient was stable for the 3 following months but was admitted again with a severe and worsening condition. MRI revealed an increased frontal lobe mass and we suggested to start a more aggressive chemotherapy approach with RMVP-ARA-C, but the patient did not survive to begin the treatment. The initial response to chemotherapy was excellent, but considering the aggressive nature of the tumor, the duration of response remained short. Methotrexate-based chemotherapy markedly improves survival, but it unfortunately did not in our patient.