Systemic Remission of Non-Hodgkin’s Lymphoma After Intralesional Interferon Alpha-2b to Bilateral Conjunctival Lymphomas
symptoms, which were well tolerated. The improvement lasted 6 months from the first IFN-A injection. CONCLUSIONS: Intralesional treatment of conjunctival lymphomas with IFN-A induced disappearance of the tumors and also had a beneficial systemic effect. (Am J Ophthalmol 2004;138:672– 673. © 2004 by Elsevier Inc. All rights reserved.)
Jonathan J. Ross, MBChB, MRCOphth, MRCSEd, Kyaw L. Tu, MBBS, FRCSEd, and Bertil E. Damato, FRCOphth, PhD
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NTERFERON 〈-2B (IFN-A) INJECTIONS FOR THE LOCALIZED
treatment of conjunctival lymphoma is an effective alternative to radiotherapy.1 We describe a patient with widespread lymphoma who declined further systemic therapy but who gained a systemic benefit from localized IFN-A injections for her conjunctival lesions. A 69-year-old woman presented in 1998 with breast lumps and an abdominal mass, a biopsy of which confirmed follicle center B cell non-Hodgkin’s lymphoma. She received cyclophosphamide 1.2 g, vincristine 2 mg, and prednisolone 60 mg (CVP regimen). This induced a 2-year remission but caused nausea and vomiting, chest infections, and peripheral vincristine neuropathy. In September 2000, she relapsed and received further CVP. This caused nausea and chest infection but induced a 1-year remission. In October 2001, left postauricular, axillary, and bilateral conjunctival lesions appeared. Ocular lesions were fleshy masses, which prevented eyelid closure. The right mass originated from the plica and the left lesion from the medial superior fornix. Computed tomographic (CT) images showed generalized lymphadenopathy and splenomegaly. Flituximab caused unacceptable fatigue but induced a
To report the beneficial systemic effect of a 5-week course of intralesional interferon ␣-2b (IFN-A) injections to bilateral conjunctival lymphomas in a patient with relapsing non-Hodgkin’s lymphoma. DESIGN: Interventional case report. METHODS: A patient in relapse with non-Hodgkin’s lymphoma who declined further systemic therapy received 1.5-million IU IFN-A injected intralesionally to each of two conjunctival lymphomas to reduce ocular discomfort. This dose was repeated 10 times over 5 weeks. RESULTS: Conjunctival, postauricular, and facial lesions clinically resolved within 3 months of the start of treatment. Inguinal lymph nodes reduced in size, and the patient reported increased well-being and less fatigue. Side effects included injection discomfort and mild flulike PURPOSE:
Accepted for publication May 5, 2004. From the St. Paul’s Eye Unit, Link 8Z, Royal Liverpool University Hospital, Prescott Street, Liverpool, England. Inquiries to Jonathan J. Ross, St. Paul’s Eye Unit, Link 8Z, Royal Liverpool University Hospital, Prescott Street, Liverpool, England, L7 8XP; e-mail:
[email protected]
FIGURE 1. Conjunctival non-Hodgkin’s lymphoma: a 7-mm fleshy mass protrudes medially from the plica, shown before a 5-week course of intralesional interferon ␣-2b.
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FIGURE 2. Resolution of non-Hodgkin’s lymphoma following treatment. Two months after commencing intralesional interferon ␣-2b injections, the fleshy mass has fully regressed.
6-month remission. In August 2002, the conjunctival, parotid, and inguinal lymphadenopathy reappeared (Figure 1). She declined further chemotherapy but agreed to intralesional IFN-A (Roferon-A, Roche, Welwyn Garden City, Herts, England) 1.5 million IU in 0.25 ml, repeated 10 times over 5 weeks to reduce ocular discomfort.1 This caused a mild flulike illness. Two months from starting the injections, her conjunctival, facial, and postauricular lesions and the ocular discomfort fully resolved (Figure 2), and her inguinal nodes partially regressed. The patient also reported increased well-being. Acuity was 6/6 in both eyes, and examination, including magnetic resonance imaging scan of the orbits, was unremarkable. In February 2003 (6 months after IFN-A injections were commenced), her facial nodes again increased in size. In March, she began chemotherapy with fludaribine 60 mg daily for 5 days, with subsequent peripheral ischemia, cold and purple feet, unsteadiness, and falls. In September 2003, she remained in remission as confirmed by CT. Treatment with IFN-A has a direct antitumor effect and an indirect effect via immune modulation in the treatment of lymphomas. Clinical stage of disease before IFN-A treatment may be more predictive of response than route of administration.2 Blasi and associates1 described the sucVOL. 138, NO. 4
cessful use of intralesional IFN-A for lymphoma localized to the conjunctiva in a series of five patients. Intralesional IFN-A has also been used with beneficial effect in the treatment of localized cutaneous lymphoma,3 whereas subcutaneous IFN-A has been used for the treatment of systemic disease in doses ranging from 3 million IU every third day to 5 million IU daily but with dose-related side effects limiting its chronic use. Our case report suggests a beneficial role for low-dose intralesional IFN-A in systemic disease when chemotherapy is not tolerated.
REFERENCES
1. Blasi MA, Gherlinzoni F, Calvisi G, et al. Local chemotherapy with interferon-alpha for conjunctival mucosa-associated lymphoid tissue lymphoma: a preliminary report. Ophthalmology 2001;108:559 –562. 2. Ross C, Tingsgaard P, Jorgensen H, et al. Interferon treatment of cutaneous T-cell lymphoma. Eur J Haematol 1993;51:63– 72. 3. Rubegni P, De Aloe G, Pianigiani E, et al. Primary cutaneous B-cell lymphoma: treatment with low dose intralesional recombinant interferon-alpha 2A. J Eur Acad Dermatol Venereol 1999;12:70 –71.
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