gms | German Medical Science

Objective: The simultaneous occurrence of a B-cell lymphoma and a cerebral glioma is a very rare condition. Adjuvant treatment options for both malignancies are very different. B-cell lymphomas respond to monoclonal antibody therapy while high-grade gliomas (HGGs) are treated with radiation therapy and alkylating chemotherapy.

Method: Here we report the near complete remission of a recurrent anaplastic astrocytoma during treatment with Rituximab for a coexisting recurrent B-cell lymphoma.

Results: A 45-year-old male patient was diagnosed in 4-2000 with a primary follicular B-cell lymphoma grade I (clinical stadium IIb) and initially treated according to the R-CHOP-scheme and inguinal radiation therapy followed by interferon therapy until 12-2002. The patient had a full remission. In April 2007, a stereotactic biopsy of a progressive parietal lesion revealed an anaplastic astrocytoma. Treatment with conformal radiation therapy followed by temozolamide (10 cycles) was initiated. Due to a further progress, treatment with bevacizumab and irinotecan was initiated for 6 months, with modest radiological response. All treatment was stopped in 10-2008. Despite a marked progression of the cerebral lesion in 12-2010, causing a hemiparesis, the patient refused therapy for the cerebral lesion. In 3-2011, the patient was diagnosed with a recurrence of the B-cell lymphoma, which was treated with Rituximab-monotherapy (375mg/sqm/week). Again the B-cell lymphoma demonstrated a complete remission. Surprisingly, cerebral MRI scans in 7-2011 revealed a near complete remission of the anaplastic astrocytoma. Last control in 10-2012 confirmed a stable and complete remission of both, the B-cell lymphoma and the anaplastic astrocytoma.

Conclusions: Rituximab is an antibody specific for the CD20 antigen present on B-cells. To our knowledge, there is yet no rationale to explain the striking response of an anaplastic astrocytoma to this treatment. There is the possibility of a very rare coincidental spontaneous remission of the anaplastic astrocytoma. However, remission may also be due to immunological effects or the reactivation of an oncolytic virus in the glioma cells.