Temozolomide・Rituximab 療法にて再寛解を得た再発性中枢神経びまん性大細胞型B細胞性リンパ腫の一例

Abstract

症例は61歳男性．52歳時，両側ぶどう膜炎を発症しIL-10/IL-6比より悪性リンパ腫が疑われ両眼及び全脳照射施行．59歳時， 右顔面神経麻痺と歩行困難出現，CTにて小脳腫瘍を認め，生検にて中枢神経びまん性大細胞型B細胞性リンパ腫再発と診断し た．Bonn Protocol施行するもその後再々発し，髄注などを施行していたが，61歳時易怒性などの人格変化を認め，MRIにて両 側大脳半球白質に腫瘍の増大を認めた．再度大量Methotrexateを用いたMPV療法を施行したが効果認めず，Temozolomide・ Rituximab療法を施行したところ，明らかなリンパ節病変の縮小を認め左不全麻痺も改善した．6コース継続し部分寛解で転院 となったが，1年5ヶ月後のMRIにて寛解状態を確認した．再発性中枢神経リンパ腫に対するTemozolomideの有効性が示唆さ れた．

A 61-year-old man was diagnosed with bilateral uveitis suspected to have been caused by malignant lymphoma due to a high ratio of IL-10/IL-6 at the age of 52．He was received radiation therapy to both eyes and total cranial irradiation．At the age of 59，he suffered from facial nerve paralysis and difficulty in walking．Computed tomography showed brain lesions in the cerebellum and biopsy findings showed recurrence of central nervous system lymphoma （ PCNSL）．After Bonn Protocol， Magnetic resonance imaging（ MRI）showed lymphoma enlargement in the white matter of both cerebral hemisphere and his personality has changed to irritable．He was given MPV therapy but it was not effective． Then we performed Temozolomide・Rituximab （ TR） therapy. The patient showed obvious reduction of lymphoma and improvement of left paresis．He remained in partial remission during six courses and was transferred to the other hospital． After one year and five months，we performed MRI and made the final diagnosis of complete response．This case suggests that TR therapy may be effective for relapse of PCNSL．