Lymphosarcoma Remission Associated With Viral Hepatitis

Abstract

A clinical and hematologic remission associated at onset with the occurrence of serum hepatitis developed in a patient with lymphocytic lymphosarcoma unresponsive to conventional therapy. No specific therapy was given to the patient for five months prior to the incident of viral hepatitis and a subsequent remission lasted for 22 months at which time the patient died in congestive heart failure.

Case Details

Disease Location

Axillary and inguinal regions

Personal Characteristics

68 -year-old male caucasion

Clinical Characteristics

Patient was admitted for the first time on july 15, 1965 with the chief complaint of weakness. The patient had excessive night sweats for six months prior to his admission, during the last two months he noted progressive anorexia, weight loss, and fatigue physical exam found a few 0.5-1cm nodes in the axillary and inguina regions, there was a grad 3/6 apical systolic murmur (this had been present for 15 years), the liver was palpated 4cm below the right costal margin and the spleen 10cm below the left costal margin lab studies revealed wbc 27k/mm^3 with 81% lymphocytes 18% polymorphonuclear cells, and 1% monocytes, hemo globin 12.1gm/100cc, reticulocytes 2%, platelets, 214k/mm^3, the bone marrow aspirate was hypercellular, 80$ of the cells were mature lymphocytes the patient's condition was classified as leukemic lymphocytic lymphosarcoma because of the rather large liver and spleen with only minimal lymphadenopathy and minimal elevation of the wbc. He was treated with a single dose of IV mechlorethamine hydrochloride (a nitrogen mustard) the following 4 weeks there was improvement in his condition the wbc and platelet counts returned to pretreatment levels but the hemoglobin value remained at 9.5gm/100cc subsequently, there was development of increased anemia, reticulocytopenia, and an enlargement of the spleen prednisone, oxymetholone were given with no change in clinical condition he required numerous blood transfusions to maintain his hemoglobin level in the range of 10gm/100cc the bone marrow remained infiltrated with lymphocytes in december 1965, 3 doses of IV cyclophosphamide were given at weekly intervals, the fourighth week he was maintained with oral cyclophophamide each day. There were no changes in his hematology during this time, the rate of fall in his hemoglobin level and tranfusion requirement increased, suggesting a hemolytic component as well as decreased production in the first week of january 1966, the spleen was removed, subsequently, the rate of fall in his hemoglobin level and transfusion requirements decreased, tranfusions were then used as necessary histology of the spleen was compatible with lymphocytic lymphosarcoma 4.5 months later in may, anorexia, fatigue, low-grade fever, and dark urine developed. These persisted for 2 weeks and was noted to be jaundiced a tender liver was palpated 8cm below the right costal margin, hemoglobin level was 10.1gm/100cc and the reticulocyte count was 1.6%, wbc was 18k/mm^3 with 50% neutrophilic granulocytes. Vilirubin level was 5.4mg/100cc (total) and 2.6mg/100cc (indirect), serum glutamic pyearsouvic transaminase level was 510u and serum alkaline phophatase was 8u. The patient was felt to have serum hepatitis and was admitted to hospital in march 1968, 22 months after the hepatitis, severe pain developed in the patients hip which prevented him from walking x-ray exam revealed severe degenerative arthritis and destruction of the joint space in the right hip, blood values were unchanged from those in may 1967. Eventually he suffered an acute congestive heart failure and died several hours after being admitted

Remission Characteristics

4 weeks following the treatment, the night sweats disappeared, the spleen decreased in size to 4cm below the left costal margin and the liver to 2cm below the right costal margin. This was associated with a fall in the wbc to 8k/mm^3, hemoglobin to 9.5gm/100cc, and platelet count to 74k/mm^3 once admitted to the hospital for the serum hepatitis, during the following 7 days the bilirubin and transaminase levels began to fall. Hepatic tenderness disappeared and the liver decreased in size as the patient's appetite returned to normal. He was discharged to convalesce at home. Within one months, liver function results were normal. Hemoglobin concentration continued to rise and in 3 weeks a plateau in the range of 14gm/100cc. 12 months after the episode of hepatitis, in may 1967, the patient was in excellent condition, returning to full activity, gained 9.1 kg and denied any fatigue or night sweats. A few small 0.5cm axillary and inguinal nodes were palpable, the liver was palpable 1.5cm below the right costal margin. Hemoglobin was 14.5gm/100cc, wbc 18k/mm^3 with 75% neutrophilic granulocytes. Bone marrow revealed normal granulocytic and erythroopoietic maturation. Megakaryocytes were present in adequate numbers and there was no lymphocytic infiltration "complete remission"

Treatment & Mechanisms

Proposed Remission Mechanisms

Suggestion of the production of interferon by virus

Clinical Treatment

IV mechlorethamine hydrochloride prednisone and oxymetholone cyclophosphamide hepatectomy

Non-Clinical Treatment

None reported