Rescue with Rituximab ® Monotherapy in Resistant T - Cell Rich B - Cell Lymphoma (TCRBCL).

TCRBCL is a large B - cell lymphoma with a prominent reactive T cell proliferation. More common in males in the fourth decade of life, usual clinical presentation includes generalized adenopathies and bone marrow involvement. More localized presentation is frequently misdiagnosed as Hodgkin’s (HL) or T - cell lymphoma. Cases resistant to anthracyclines (A) pose a medical dilemma. We present here a patient initially misdiagnosed as HL who showed nodal relapse after ABVD and was resistant to conventional chemotherapy. Case report: CP is a 45 years old gentleman who presented with left axillaries adenophaties. A lymph node biopsy was diagnosed as lymphocyte predominant HL (LPHL) stage IA. Treated with 3 cycles of ABVD plus involved field radiation therapy, he relapsed in the margin of the radiation field soon after treatment was completed. A new biopsy showed TCRBCL. A review of the first biopsy was also consistent with TCRBCL. Treated with Promace/Cytabom the patient experience a spleen relapse which was resistant to ESHAP. With a gross hypo dense image in the spleen, treatment with R was started at a dose of 375 mg sqm 2 weekly for four weeks. Disappearance of the splenic mass on the CT scan prompted us to perform a splenectomy. The pathologic study revealed a residual 8 mm lesion. The patient is currently without evidence of disease 40 months after the splenectomy. In total he received 6 doses of R. Interestingly an additional patient with TCRBCL originally misdiagnosed as ABVD resistant HL, showed a durable partial remission after treatment with R. In conclusion: due to our experience we think that it might be worth including R in the front line treatment of TCRBCL.