gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Remission of a cerebral anaplastic astrocytoma after treatment with Rituximab: Case report

Meeting Abstract

  • Maria Angela Samis Zella - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • Rüdiger Sorg - Institut für Transplantationsdiagnostik und Zelltherapeutika, Universitätsklinikum Düsseldorf
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • Günther Schmutz - Onkologische Gemeinschaftspraxis, Düsseldorf
  • Michael Sabel - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 148

doi: 10.3205/13dgnc565, urn:nbn:de:0183-13dgnc5653

Published: May 21, 2013

© 2013 Zella et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.