Chemosensitive epidural spinal cord disease in non-Hodgkins lymphoma Journal Article
| Authors: | Wong, E. T.; Portlock, C. S.; O'Brien, J. P.; DeAngelis, L. M. |
| Article Title: | Chemosensitive epidural spinal cord disease in non-Hodgkins lymphoma |
| Abstract: | Epidural spinal cord disease (ESCD), an infrequent complication of systemic non-Hodgkins lymphoma (NHL), can occur at diagnosis or at relapse, and is usually treated with radiotherapy, or infrequently surgical decompression. We retrospectively analyzed 140 patients with intermediate- grade NHL (IG-NHL) who were treated on a dose-intense protocol using doxorubicin, vincristine, and high-dose cyclophosphamide (NHL-15). There were seven episodes of ESCD in six (4.3%) patients. Five episodes were asymptomatic at presentation; one patient had back pain, leg numbness, and tingling; and one had radicular pain and mild leg weakness. None had malignant cells in the CSF. One patient received high-dose dexamethasone after laminectomy for diagnostic biopsy; otherwise, dexamethasone was used only as an anti-emetic prior to chemotherapy. Patients who developed ESCD at diagnosis received the planned course of NHL-15 chemotherapy as treatment for ESCD, and those treated with NHL-15 who developed ESCD at relapse were given a regimen containing ifosfamide, carboplatin, and etoposide (ICE). After chemotherapy alone, five of seven episodes showed radiographic resolution of ESCD and improvement of neurologic deficits. One patient received consolidation radiotherapy (2,700 cGy) to the spine after ICE for relapsed ESCD and had a complete response. One patient had progression of systemic lymphoma and ESCD despite chemotherapy. These data suggest that chemotherapy may be effective as initial treatment of ESCD in IG-NHL and may reduce the potential complications of spinal surgery and radiotherapy. |
| Keywords: | adolescent; adult; human tissue; treatment outcome; aged; middle aged; retrospective studies; major clinical study; clinical trial; neutropenia; salvage therapy; cisplatin; doxorubicin; dose response; chemotherapy; gadolinium; methotrexate; nuclear magnetic resonance imaging; magnetic resonance imaging; carboplatin; phase 2 clinical trial; etoposide; antineoplastic combined chemotherapy protocols; cyclophosphamide; dexamethasone; vincristine; clinical protocol; ifosfamide; nonhodgkin lymphoma; contrast enhancement; ondansetron; antiemetic agent; antiemetics; mesna; drug sensitivity; granulocyte colony stimulating factor; granulocyte colony-stimulating factor; intravenous drug administration; spinal cord disease; laminectomy; spinal cord neoplasms; epidural space; subcutaneous drug administration; humans; human; priority journal; article; lymphoma, intermediate-grade; intrathecal drug administration |
| Journal Title: | Neurology |
| Volume: | 46 |
| Issue: | 6 |
| ISSN: | 0028-3878 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 1996-06-01 |
| Start Page: | 1543 |
| End Page: | 1547 |
| Language: | English |
| PUBMED: | 8649545 |
| PROVIDER: | scopus |
| DOI: | 10.1212/WNL.46.6.1543 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 22 November 2017 -- Source: Scopus |
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204Portlock -
28O'Brien
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