钇-90微球脾放射栓塞:治疗恶性脾肿大淋巴瘤的新途径

Jasmine Nguyen, Kristoff Muylle, Thi Kim Tran, Radu Firescu, Martine Roelandts, Carine Moerman, Nathalie Meuleman, Patrick Flamen, Dominique Bron
{"title":"钇-90微球脾放射栓塞:治疗恶性脾肿大淋巴瘤的新途径","authors":"Jasmine Nguyen,&nbsp;Kristoff Muylle,&nbsp;Thi Kim Tran,&nbsp;Radu Firescu,&nbsp;Martine Roelandts,&nbsp;Carine Moerman,&nbsp;Nathalie Meuleman,&nbsp;Patrick Flamen,&nbsp;Dominique Bron","doi":"10.3816/CLM.2009.n.094","DOIUrl":null,"url":null,"abstract":"<div><p>To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM.</p></div><div><h3>Full Abstract</h3><p></p></div><div><h3>Introduction</h3><p>90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases.</p></div><div><h3>Patients and Methods</h3><p>A 77-year-old man with marginal zone lymphoma CD20<sup>+</sup> and CD5, CD10, CD23<sup>−</sup> developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts.</p></div><div><h3>Discussion</h3><p>Radioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated.</p></div><div><h3>Conclusion</h3><p>This case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.</p></div>","PeriodicalId":100272,"journal":{"name":"Clinical Lymphoma and Myeloma","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3816/CLM.2009.n.094","citationCount":"0","resultStr":"{\"title\":\"Yttrium-90 Microsphere Radioembolization of the Spleen: A New Approach for the Treatment of Malignant Lymphomatous Splenomegaly\",\"authors\":\"Jasmine Nguyen,&nbsp;Kristoff Muylle,&nbsp;Thi Kim Tran,&nbsp;Radu Firescu,&nbsp;Martine Roelandts,&nbsp;Carine Moerman,&nbsp;Nathalie Meuleman,&nbsp;Patrick Flamen,&nbsp;Dominique Bron\",\"doi\":\"10.3816/CLM.2009.n.094\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM.</p></div><div><h3>Full Abstract</h3><p></p></div><div><h3>Introduction</h3><p>90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases.</p></div><div><h3>Patients and Methods</h3><p>A 77-year-old man with marginal zone lymphoma CD20<sup>+</sup> and CD5, CD10, CD23<sup>−</sup> developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts.</p></div><div><h3>Discussion</h3><p>Radioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated.</p></div><div><h3>Conclusion</h3><p>This case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.</p></div>\",\"PeriodicalId\":100272,\"journal\":{\"name\":\"Clinical Lymphoma and Myeloma\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2009-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.3816/CLM.2009.n.094\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Lymphoma and Myeloma\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1557919011700452\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Lymphoma and Myeloma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1557919011700452","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

据我们所知,用90y标记微球进行放射栓塞治疗淋巴瘤尚未见报道。一例77岁男性边缘带淋巴瘤伴症状性脾肿大(SM)患者接受3700 MBb治疗。该方法安全有效,值得在淋巴瘤或其他恶性SM中进一步研究。90y标记微球(90YRE)用于肝肿瘤的局部治疗。据我们所知,它从未被报道为淋巴瘤疾病的治疗方法。患者和方法一例77岁男性边缘区淋巴瘤(CD20+和CD5、CD10、CD23−)患者发生淋巴瘤性白血病伴症状性脾肿大(SM)。在几次化疗后,患者进展为一种侵袭性临床疾病,脾脏肿大导致白细胞过多,超过200000/μL,需要定期输血的贫血,腹痛和厌食症。用16gy对脾脏进行姑息性照射可使血液系统短暂稳定。为减少脾体积,我们行90YRE。3700 MBb的90y标记微球(SIRTEX®)经脾动脉选择性给药,相当于36 Gy的总剂量(根据治疗模拟/用锝-99m标记的白蛋白大聚体剂量测定计算)。这种不寻常的手术是安全的,并导致血细胞计数完全正常化。放射栓塞治疗肝肿瘤是一种众所周知的安全方法。几年前曾报道过一个类似的手术,成功地治疗了由特发性肝硬化引起的充血性脾功能亢进。经经典入路和脾切除术的放射栓塞通常伴有严重的并发症。照射可损伤邻近器官。在我们的患者中,90YRE耐受良好,脾体积减少。尽管主要髓质浸润有循环白血病细胞,但BCC的完全正常化表明,储存或通过脾脏循环的淋巴瘤细胞的照射主要起作用。反应持续时间为3个月,最近重复治疗。结论90YRE手术是一种安全有效的治疗方法,值得进一步研究。事实上,这种方法比传统的栓塞疗法耐受性更好,在这种高度难治性患者中取得了令人印象深刻的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Yttrium-90 Microsphere Radioembolization of the Spleen: A New Approach for the Treatment of Malignant Lymphomatous Splenomegaly

To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM.

Full Abstract

Introduction

90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases.

Patients and Methods

A 77-year-old man with marginal zone lymphoma CD20+ and CD5, CD10, CD23 developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts.

Discussion

Radioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated.

Conclusion

This case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信