Korean J Hematol.  2012 Dec;47(4):293-297. 10.5045/kjh.2012.47.4.293.

Successful treatment of diffuse large B-cell lymphoma with clarithromycin and prednisolone

• Ohe M
• Hashino S
• Hattori A

• KMID: 1832109
• DOI: http://doi.org/10.5045/kjh.2012.47.4.293

Abstract

We report a case of diffuse large B-cell lymphoma (DLBCL) treated successfully with clarithromycin (CAM) and prednisolone (PSL). A 71-year-old woman presented with fever and cervical pain. DLBCL was diagnosed based on histological results from lymph node biopsy. Cervical pain was thought to be caused by the invasion of lymphoma cells into the cervical vertebrae. She initially received radiotherapy for the cervical lesion. She did not receive conventional chemotherapy because of the risk of recurrent non-tuberculous mycobacteria infection; therefore, she was treated with 20 mg/day PSL and 800 mg/day CAM to induce apoptosis in lymphoma cells. Complete remission was achieved after 6 months. The present findings suggest that CAM and PSL may be effective in some cases of DLBCL.

Keyword

Diffuse large B-cell lymphoma; Clarithromycin; Prednisolone; Apoptosis

MeSH Terms

Apoptosis
B-Lymphocytes
Biopsy
Cervical Vertebrae
Clarithromycin
Female
Fever
Humans
Lymph Nodes
Lymphoma
Lymphoma, B-Cell
Neck Pain
Prednisolone
Clarithromycin
Prednisolone

Figure

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  Fig. 1 Computed tomography (CT). (A) Chest CT revealing left axillary lymphadenopathy at admission. (B) Chest CT revealing no left axillary lymphadenopathy 6 months after initiation of clarithromycin and prednisolone treatment.

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  Fig. 2 Bone CT and bone scintigram. (A) Bone CT revealing bone destruction of the axis at admission. (B) Bone scintigram revealing abnormal uptake into vertebrae, sternum, ribs, left scapula, pelvis, and right femur at admission.

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  Fig. 3 Fluorodeoxyglucose (FDG)-positron emission tomography (PET). (A) FDG-PET revealing increased spotty uptake into vertebrae, sternum, rib bones, pelvis, right femur, and bilateral axillary lymph nodes, and moderate serial uptake into the cervical to lumbar-region vertebrae at admission. (B) FDG-PET showing no abnormal uptake 6 months after initiation of clarithromycin and prednisolone treatment.

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  Fig. 4 Histological and immunohistochemical examination of left axillary lymph node biopsy specimens. (A) Histological examination revealing proliferation of atypical large lymphocytes with pleomorphic, irregular nuclei and prominent nucleoli, accompanied by small lymphocytes (hematoxylin and eosin stain ×400). (B) Immunohistochemical examination for CD20 exhibiting positive staining in large lymphocytes (immunohistochemical stain ×400). (C) Immunohistochemical examination for bcl-2 exhibiting positive staining in large lymphocytes (immunohistochemical stain ×400). (D) Immunohistochemical examination for MIB-1 exhibiting positive staining in large lymphocytes (immunohistochemical stain ×400).

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