Treatment for orbital diffuse large B-cell lymphoma in an elderly patient by autologous cytokine-induced killer cells

Abstract

Dear Editor, Ocular adnexal lymphomas (OALs) are largely represented by extranodal marginal zone lymphomas, about 10% are diffuse large B-cell lymphomas (DLBCLs) [1, 2]. The prognosis of DLBCL worsens with age. Therefore, the treatment must be tailored to the condition of the individual elderly patient. Autologous cytokine-induced killer (CIK) cells have been shown to be effective in the treatment of cancer and minimal residual diseases. Here, we report on CIK cells treatment in an elderly orbital DLBCL patient. In May 2009, an 89-year-old patient was admitted to the department of ophthalmology because of a mass in his right eye for 2 months without any other symptoms. After the mass was partly exsected, histopathological diagnosis was DLBCL of the right orbit and immunohistochemical analyses showed CD20+++/MUM-1+/bcl-6+/CD10-/ CD5-/CD3-/Cyclin D1-. In July 2009, the patient was referred to our department for further therapy. A detailed examination showed a possible involvement of the upper pole of the left kidney, extensive enlargement of the lymph nodes, and splenomegaly. He was determined to be stage IV. Because of his age, severe pulmonary and cardiac comorbidities, rituximab was used as the principal therapy. Rituximab was given at a dose of 600 mg once a week for 2 weeks from July 31, 2009, after he signed the informed consent. Twenty days later, the regimen of R-COP (rituximab 0.6 g d1, CTX 0.6 g d3, VDS 2 mg d3, Dex 10 mg d3, Dex 7.5 mg d4-7) was given; the orbital mass, possible involvement of left kidney, and lymph nodes all became smaller, and a partial remission was obtained. But the patient refused to use rituximab and chemotherapy because of some cardiac adverse effects. After this, he received 5 cycles of CIK cells infusion. The first cycle of CIK cell infusion was on October 29, 2009. It had been 2 months from the end of R-COP chemotherapy to the beginning of CIK treatment. His orbital lymphoma and possible involvement of the kidney disappeared after the second cycle of CIK infusion (see Fig. 1). PET showed complete remission on January 25, 2010. The last one was on July 23, 2010. At the end of treatment, enlarged lymph nodes of CT became normal. The side effects of CIK cells treatment were minor. Presently, 20 months after diagnosis, the patient lives well and continues in complete remission. Ocular DLBCL is an uncommon disorder of OALs, rituximab with CHOP has shown good efficacy in treating DLBCL. However, the tolerance is poor for many elderly patients. CIK cells are T lymphocytes that are enriched with CD3CD56 cells, which can be easily and rapidly expanded in vitro from human peripheral blood. It is a promising new treatment that has the potential to kill a wide spectrum of tumor cells, especially malignant hematological diseases [3–6]. The peripheral blood mononuclear cells were isolated and primed with anti-CD3 monoclonal antibody, interferon-γ, interleukin (IL)-2, and IL-1. After 14 days of culture, the immunophenotype and survival rate of the CIK cells were determined with a flow cytometer, then CIK cells were transfused. One course of the therapy was defined as follows: about 2–3×10 of CIK cells (survival rate >95%) were transfused twice, then rhIL-2 S.-X. Li :H.-L. Zhu (*) :B. Guo :X.-C. Lu : B. Yang :Y. Liu : S.-Q. Yao Department of Geriatric Hematology, Chinese People’s Liberation Army General Hospital, Beijing 100853, China e-mail: bjzhuhl301@vip.sina.com