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DOI 10.23648/UMBJ.2018.31.17219

УДК 616-039.74/616-006

 

МЕСТО ХИРУРГИИ В КОМБИНИРОВАННОМ ЛЕЧЕНИИ MALT-ЛИМФОМЫ ЛЕГКОГО

 

Е.А. Тонеев1,2, А.А. Мартынов1, А.Л. Чарышкин2, Д.В. Базаров3, М.М. Лазаревский1

1ГУЗ Областной клинический онкологический диспансер, г. Ульяновск, Россия;

2ФГБОУ ВО «Ульяновский государственный университет», г. Ульяновск, Россия;

3ФГБНУ «Российский научный центр хирургии им. академика Б.В. Петровского», г. Москва, Россия

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Лечение MALT-лимфом легкого остается актуальной проблемой торакальной онкологии ввиду малого числа наблюдений и ряда нерешенных вопросов комбинированного лечения. Цель – показать благоприятный исход радикального лечения у больной MALT-лимфомой легкого.

Материалы и методы. В данной работе показан клинический случай MALT-лимфомы легкого и результаты применения хирургического метода в комбинированном лечении данной патологии. При предоперационном обследовании пациентки М. (40 лет) была выявлена картина объемного образования нижней доли правого легкого. Проведена нижняя лобэктомия, частичная резекция верхней доли, системная ипсилатеральная лимфодиссекция.

Результаты. Гистологическое исследование операционного материала выявило картину MALT-лимфомы легкого. В послеоперационном периоде проведена химиотерапия: 6 курсов по схеме R-СНОР-21. Далее проводили поддерживающую таргетную терапию: ритуксимаб 1 раз в 3 мес. на протяжении 2 лет. Контрольное исследование через 3 года не выявило рецидива лимфомы и наличия отдаленных метастазов.

Выводы. Своевременная диагностика, выполнение радикального оперативного лечения и выбор адекватной схемы иммунохимиотерапии R-СНОР-21 позволили добиться радикального излечения у больной MALT-лимфомой легкого.

Ключевые слова: MALT-лимфома легкого, лобэктомия, системная ипсилатеральная лимфодиссекция, комбинированное лечение, полихимиотерапия.

Литература

  1. Danielle L. Drayton, Shan Liao, Rawad H. Mounzer, Nancy H. Ruddle. Lymphoid organ development: from ontogeny to neogenesis. Nature Immunology. 2006; 7: 344–353. DOI: 10.1038/ni1330.

  2. Богданов А.Н., Максимов А.Г., Саржевский В.О., Аносов Н.А. Особые формы неходжкинских лимфом. Практическая онкология. 2004; 5 (3): 216–222. URL: https://elibrary.ru/item.asp?id=19394692.

  3. Stefanovic A., Morgensztern D., Fong T., Lossos I.S. Pulmonary marginal zone lymphoma: a single centre experience and review of the SEER database. Leuk Lymphoma. 2008; 49 (7): 1311–1320. URL: https://doi.org/10.1080/10428190802064933.

  4. Ahmed S., Kussick S.J., Siddiqui A.K., Bhuiya T.A., Khan A., Sarewitz S., Steinberg H., Sison C.P., Rai K.R. Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease. Eur. J. Cancer. 2004; 40 (9): 1320–1326. URL: https://doi.org/10.1016/j.ejca.2004.02.006.

  5. Isaacson P.G., Spencer J. The biology of low grade MALT lymphoma. J. Clin. Pathol. 1995; 48 (5): 395–397. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC502609/.

  6. Chan J.K., Banks P.M., Cleary M.L., Delsol G., De Wolf-Peeters C. A revised European-American classification of lymphoid neoplasms proposed by the International Lymphoma Study Group. A summary version. Am. J. Clin. Pathol. 1995; 103 (5): 543–560. URL: https://www.ncbi.nlm.nih. gov/pmc/issues/16085/.

  7. Морозова А.К., Габеева Н.Г., Звонков Е.Е. MALT-лимфома с поражением легкого: клиническое наблюдение и обзор литературы. Клиническая онкогематология. 2013; 6 (3): 282–288.

  8. Brito-Zerón P., Kostov B., Fraile G., Caravia-Durán D., Maure B. Characterization and risk estimate of cancer in patients with primary Sjögren syndrome. J. Hematol. Oncol. 2017; 10 (1). DOI: 10.1186/s13045-017-0464-5.

  9. Yasutaka Watanabe, Shinichiro Koyama, Chihiro Miwa, Shinya Okuda, Yoshihiko Kanai, Kenji Tetsuka, Mitsuhiro Nokubi, Yoh Dobashi, Yoshinori Kawabata, Yoshinobu Kanda, Shunsuke Endo. Pulmonary Mucosa-associated Lymphoid Tissue (MALT) Lymphoma in Sjögren's Syndrome Showing Only the LIP Pattern Radiologically. Intern. Med. 2012; 51 (5): 491–495. URL: https://doi.org/10.2169/internalmedicine.51.6242.

  10. Pan Hellenic. BALT lymphoma: a 15-year retrospective study – difficulties in diagnosis-identification. Journal of Thoracic Disease. 2015; 7 (suppl. 1). URL: http://jtd.amegroups.com/article/view/3884/4276.

  11. Bilici A., Seker M., Ustaalioglu B.B., Canpolat N., Salepci T., Gumus M. Pulmonary BALT lymphoma successfully treated with eight cycles weekly rituximab: report of first case and F-18 FDG PET/CT images. J. Korean Med. Sci. 2011; 26 (4): 574–576. URL: https://doi.org/10.3346/jkms.2011.26.4.574.

  12. Simona Sammassimo, Giancarlo Pruneri, Giovanna Andreola, Juan Montoro, Sara Steffanoni. A retrospective international study on primary extranodal marginal zone lymphoma of the lung (BALT lymphoma) on behalf of International Extranodal Lymphoma Study Group (IELSG). Hematological Oncology. 2016; 34 (4): 177–183. DOI: 10.1002/hon.2243.

  13. Vanden Eynden F., Fadel E., de Perrot M., de Montpreville V., Mussot S., Dartevelle P. Role of surgery in the treatment of primary pulmonary B-cell lymphoma. Ann. Thorac. Surg. 2007; 83: 236–240. URL: https://doi.org/10.1016/j.athoracsur.2006.08.026.

  14. Tsang R.W., Gospodarowicz M.K., Pintilie M., Bezjak A., Wells W., Hodgson D.C., Crump M. Stage I and II MALT lymphoma: results of treatment with radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2001; 50 (5): 1258–1264. URL: https://www.ncbi.nlm.nih.gov/pubmed/11483337.

  15. Hideomi Yamashita, Naoya Murakami, Hiroshi Igaki, Kuni Ohtomo. Radiotherapy for 41 patients with stages I and II MALT lymphoma: A retrospective study. Radiotherapy and Oncology. 2008; 87 (3): 412–417. URL: http://dx.doi.org/10.1016/j.radonc.2008.03.012.

  16. Aguiar Bujanda D., Bohn Sarmiento U., Saura Grau S., Rodriguez Franco C., Aguiar Morales J., Show More. Clinical activity of rituximab with either CHOP or CVP in MALT lymphoma. Journal of Clinical Oncology. 2009; 27 (15S ). DOI: 10.1200/jco.2009.27.15s.e19530.

  17. Misato Kikuchi, Hideki Nakasone, Yu Akahoshi, Hirofumi Nakano. Reduced-dose (two-thirds) R-CHOP chemotherapy for elderly patients with non-Hodgkin lymphoma. J. Chemother. 2015; 27 (2): 99–105. URL: https://doi.org/10.1179/1973947814Y.0000000219.

  18. Ian W. Flinn, Richard van der Jagt, Brad S. Kahl, Peter Wood. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014; 123 (19): 2944–2952. URL: https://dx.doi.org/10.1182%2Fblood-2013-11-531327.

  19. Starr A.G., Caimi P.F., Fu P., Massoud M.R., Meyerson H., Hsi E.D. Dual institution experience of nodal marginal zone lymphoma reveals excellent long-term outcomes in the rituximab era. Br. J. Haematol. 2016; 175 (2): 275–280. DOI: 10.1111/bjh.14228.

  20. L’Hoste R.J., Filippa D.A., Lieberman P.H., Bretsky S. Primary pulmonary lymphomas (A clinicpathologic analysis of 36 cases). Cancer. 1984; 54: 1397–1406. URL: https://www.ncbi.nlm.nih.gov/ pubmed/6467161?dopt=Abstract.

  21. Shahid Ahmed, Steven J. Kussick, Anita K. Siddiqui, Tawfiqul A. Bhuiya, Arfa Khan, Stephen Sarewitz, Harry Steinberg, Cristina P. Sison, Kanti R. Rai. Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease. Еuropean journal cancer. 2004; 40 (9): 1320–1326. URL: http://dx.doi.org/10.1016/j.ejca.2004.02.006.

 

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DOI 10.23648/UMBJ.2018.31.17219

SURGERY IN COMBINED TREATMENT OF PULMONARY MALT-LYMPHOMA

 

E.A. Toneev1,2, A.A. Martynov1, A.L. Charyshkin2, D.V. Bazarov3, M.M. Lazarevskiy1

1Regional Clinical Oncology Center, Ulyanovsk, Russia;

2Ulyanovsk State University, Ulyanovsk, Russian;

3Russian National Research Center of Surgery named after B.V. Petrovsky, Moscow, Russia

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Treatment of pulmonary MALT-lymphomas remains an urgent problem of thoracic oncology due to their rareness and a number of unresolved issues of combined treatment. The objective of the paper is to show a favorable outcome of radical treatment in patients with pulmonary MALT-lymphoma.

Materials and Methods. This paper describes a clinical case of pulmonary MALT-lymphoma and gives the results of surgical method in its combined treatment. During the preoperative examination of patient M. (40 years old) a malignant neoplasm was detected in the lower lobe of the right lung. The patient underwent the lower lobectomy, partial resection of the upper lobe, and systemic ipsilateral lymphadenectomy.

Results. Histological examination of the surgery material revealed pulmonary MALT-lung lymphoma. During the postoperative period, the patient underwent chemotherapy: 6 treatment cycles according to R-CHOP-21 scheme. Then, supportive targeted therapy was performed: rituximab one dose every 3 months for 2 years. A control study carried out 3 years after treatment did not reveal a lymphoma recurrence or any distant metastases.

Conclusion. Timely diagnosis, radical surgical treatment and adequate immunochemotherapy according to R-SNOR-21 scheme made it possible to register radical recovery in a patient with pulmonary MALT-lymphoma.

Keywords: pulmonary MALT-lymphoma, lobectomy, systemic ipsilateral lymphadenectomy, combined treatment, polychemotherapy.

References

  1. Danielle L. Drayton, Shan Liao, Rawad H. Mounzer, Nancy H. Ruddle. Lymphoid organ development: from ontogeny to neogenesis. Nature Immunology. 2006; 7: 344–353. DOI: 10.1038/ni1330.

  2. Bogdanov A.N., Maksimov A.G., Sarzhevskiy V.O., Anosov N.A. Osobye formy nekhodzhkinskikh limfom [Special forms of non-Hodgkin lymphomas]. Prakticheskaya onkologiya. 2004; 5 (3): 216–222. Available at: https://elibrary.ru/item.asp?id=19394692 (in Russian).

  3. Stefanovic A., Morgensztern D., Fong T., Lossos I.S. Pulmonary marginal zone lymphoma: a single centre experience and review of the SEER database. Leuk Lymphoma. 2008; 49 (7): 1311–1320. Available at: https://doi.org/10.1080/10428190802064933.

  4. Ahmed S., Kussick S.J., Siddiqui A.K., Bhuiya T.A., Khan A., Sarewitz S., Steinberg H., Sison C.P., Rai K.R. Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease. Eur. J. Cancer. 2004; 40 (9): 1320–1326. Available at: https://doi.org/10.1016/j.ejca.2004.02.006.

  5. Isaacson P.G., Spencer J. The biology of low grade MALT lymphoma. J. Clin. Pathol. 1995; 48 (5): 395–397. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC502609/.

  6. Chan J.K., Banks P.M., Cleary M.L., Delsol G., De Wolf-Peeters C. A revised European-American classification of lymphoid neoplasms proposed by the International Lymphoma Study Group.

    A summary version. Am. J. Clin. Pathol. 1995; 103 (5): 543–560. Available at: https://www.ncbi.nlm.nih.gov/pmc/issues/16085/.

  7. Morozova A.K., Gabeeva N.G., Zvonkov E.E. MALT-limfoma s porazheniem legkogo: klinicheskoe nablyudenie i obzor literatury [Pulmonary MALT-lymphoma: case report and literature review]. Klinicheskaya onkogematologiya. 2013; 6 (3): 282–288 (in Russian).

  8. Brito-Zerón P., Kostov B., Fraile G., Caravia-Durán D., Maure B. Characterization and risk estimate of cancer in patients with primary Sjögren syndrome. J. Hematol. Oncol. 2017; 10 (1). DOI: 10.1186/s13045-017-0464-5.

  9. Yasutaka Watanabe, Shinichiro Koyama, Chihiro Miwa, Shinya Okuda, Yoshihiko Kanai, Kenji Tetsuka, Mitsuhiro Nokubi, Yoh Dobashi, Yoshinori Kawabata, Yoshinobu Kanda, Shunsuke Endo. Pulmonary Mucosa-associated Lymphoid Tissue (MALT) Lymphoma in Sjögren's Syndrome Showing Only the LIP Pattern Radiologically. Intern. Med. 2012; 51 (5): 491–495. Available at: https://doi.org/10.2169/internalmedicine.51.6242.

  10. Pan Hellenic. BALT lymphoma: a 15-year retrospective study – difficulties in diagnosis-identification. Journal of Thoracic Disease. 2015; 7 (suppl. 1). Available at: http://jtd.amegroups.com/article/view/3884/4276.

  11. Bilici A., Seker M., Ustaalioglu B.B., Canpolat N., Salepci T., Gumus M. Pulmonary BALT lymphoma successfully treated with eight cycles weekly rituximab: report of first case and F-18 FDG PET/CT images. J. Korean Med. Sci. 2011; 26 (4): 574–576. Available at: https://doi.org/10.3346 /jkms.2011.26.4.574.

  12. Simona Sammassimo, Giancarlo Pruneri, Giovanna Andreola, Juan Montoro, Sara Steffanoni. A retrospective international study on primary extranodal marginal zone lymphoma of the lung (BALT lymphoma) on behalf of International Extranodal Lymphoma Study Group (IELSG). Hematological

    Oncology. 2016; 34 (4): 177–183. DOI: 10.1002/hon.2243.

  13. Vanden Eynden F., Fadel E., de Perrot M., de Montpreville V., Mussot S., Dartevelle P. Role of surgery in the treatment of primary pulmonary B-cell lymphoma. Ann. Thorac. Surg. 2007; 83: 236–240. Available at: https://doi.org/10.1016/j.athoracsur.2006.08.026.

  14. Tsang R.W., Gospodarowicz M.K., Pintilie M., Bezjak A., Wells W., Hodgson D.C., Crump M. Stage I and II MALT lymphoma: results of treatment with radiotherapy. Int. J. Radiat. Oncol. Biol. Phys. 2001; 50 (5): 1258–1264. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11483337.

  15. Hideomi Yamashita, Naoya Murakami, Hiroshi Igaki, Kuni Ohtomo. Radiotherapy for 41 patients with stages I and II MALT lymphoma: A retrospective study. Radiotherapy and Oncology. 2008; 87 (3): 412–417. Available at: http://dx.doi.org/10.1016/j.radonc.2008.03.012.

  16. Aguiar Bujanda D., Bohn Sarmiento U., Saura Grau S., Rodriguez Franco C., Aguiar Morales J., Show More. Clinical activity of rituximab with either CHOP or CVP in MALT lymphoma. Journal of Clinical Oncology. 2009; 27 (15S). DOI: 10.1200/jco.2009.27.15s.e19530.

  17. Misato Kikuchi, Hideki Nakasone, Yu Akahoshi, Hirofumi Nakano. Reduced-dose (two-thirds)

    R-CHOP chemotherapy for elderly patients with non-Hodgkin lymphoma. J. Chemother. 2015; 27 (2): 99–105. Available at: https://doi.org/10.1179/1973947814Y.0000000219.

  18. Ian W. Flinn, Richard van der Jagt, Brad S. Kahl, Peter Wood. Randomized trial of bendamustine-rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: the BRIGHT study. Blood. 2014; 123 (19): 2944–2952. Available at: https://dx.doi.org/10.1182%2Fblood-2013-11-531327.

  19. Starr A.G., Caimi P.F., Fu P., Massoud M.R., Meyerson H., Hsi E.D. Dual institution experience of nodal marginal zone lymphoma reveals excellent long-term outcomes in the rituximab era. Br. J. Haematol. 2016; 175 (2): 275–280. DOI: 10.1111/bjh.14228.

  20. L’Hoste R.J., Filippa D.A., Lieberman P.H., Bretsky S. Primary pulmonary lymphomas

    (A clinicopathologic analysis of 36 cases). Cancer. 1984; 54: 1397–1406. Available at: https://www.ncbi.nlm.nih.gov/pubmed/6467161?dopt=Abstract.

  21. Shahid Ahmed, Steven J. Kussick, Anita K. Siddiqui, Tawfiqul A. Bhuiya, Arfa Khan, Stephen Sarewitz, Harry Steinberg, Cristina P. Sison, Kanti R. Rai. Bronchial-associated lymphoid tissue lymphoma: a clinical study of a rare disease. Еuropean Journal Cancer. 2004; 40 (9): 1320–1326. Available at: http://dx.doi.org/10.1016/j.ejca.2004.02.006.