Spontaneous Regression Of Mantle Cell Lymphoma: A Report Of Four Cases
Ye, H., Desai, A., Gong, T., Zeng, D., Nomie, K., Chen, W., Wang, W., Romaguera, J., & Wang, M. L. (2018). spontaneous regression of mantle cell lymphoma: a report of four cases. Cancer communications (London, England), 38(1), 30. https://doi.org/10.1186/s40880-018-0306-z
View Original Source →Abstract
Spontaneous regression has been reported in some indolent forms of lymphoma. Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm and has a poor prognosis. However, approximately 30% of MCL patients can exhibit indolent clinical behavior. To date, complete spontaneous regression of MCL has not been reported. We describe four cases of spontaneous regression of MCL. At the time of presentation, these patients were asymptomatic, with lymph node enlargement and mild to moderate fluorodeoxyglucose (FDG) uptake on FDG-positron emission tomography combined with computed tomography. One of the possible mechanisms of spontaneous regression of the tumor could be due to the host immune response through humoral and cellular immunity, which may have a role in the clearance of tumor cells. In this report, we support the use of a “wait and watch” strategy for MCL patients with no risk factors and indolent behavior. This strategy helps spare patients from further potentially harmful chemotherapy. In addition, we describe the phenomenon of spontaneous regression in MCL patients who are asymptomatic and have low-volume disease.
Case Details
Disease Location
Right inguinal ln
Personal Characteristics
48 -year-old male
Clinical Characteristics
Mantle cell lymphoma (mcl) diagnosed in july 2010 from an excisional biopsy of the right inguinal ln pathology was reported as classic mcl with a ki-67 value of 10-15%. Bone marrow biopsy revealed less than 5% involvement. Marrow aspirate flow cytometry showed a small population of phenotypically aberrant CD5 positive b cells monotypic for lambda light chain at presentation, mipi score was 2 (one for serum ldh and one from wbc count) initially was treated with serial monitoring; however, 3 months later developed progressive disease and was enrolled in a clinical trial with reituximab, cladribine, and vorinostat; receiving 6 cycles of chemo between september 2010 and feb 2011. In september 2011, a left inguinal ln grew and recurrence of mcl was confirmed by core needle biopsy pathology report described a diffuse lymphoid infiltrate of non-blastoid cytology composed of small- to medium-sized lymphoid cells that were cyclin d1-positive
Remission Characteristics
He achieved complete remission and received maintaince therapy with rituximab every 2 months between march 2011 and august 2011 after the recurrence in september 2011, without therapy, the residual adenopathy regressed spontaneously after the first follow-up. Most recent PET-CT in november 2016 still showed no evidence of lymphoma
Treatment & Mechanisms
Proposed Remission Mechanisms
The host immune response through humoral and cellular immunity may play a central role in the clearance of tumor cells and contribute to sr (article discussion talks about a lot of different potential sr mechanisms but this is their final hypothesis)
Clinical Treatment
Excisional biopsy initial treatment of serial monitoring, then 6 cycles of chemo including rituximab, cladribine, and vorinostat maintenance therapy with rituximab every 2 months
Non-Clinical Treatment
None reported