Abstract
BACKGROUND
Primary cutaneous marginal zone B-cell lymphomas (PCMZL) are low-grade lymphomas with an indolent course, but with a high rate of skin relapses. Surgical excision, local radiotherapy, or combinations of both are the first-line treatment in solitary or localized disease. Therapeutic options in cases of multifocal disease or relapse, include steroids or intravenous Rituximab in monotherapy or in combination with intravenous or oral chemotherapy. The effectiveness of intralesional Rituximab (ILR) in primary cutaneous B-cell lymphomas has been described in a small multicenter series of patients.
OBJECTIVE
To evaluate the effectiveness and safety of ILR in patients with PCMZL.
METHODS
In our center ILR is used since 2010 as fist-line treatment for patients with PCMZL with single facial lesions, multifocal disease that cannot be irradiated or in relapsed disease. The treatment regimen consist of a course of three injections of 10 mg (days 1, 3 and 5) in a single week at monthly intervals. Oral paracetamol and dexclorfeniramine were administrated 30 minutes before the procedure. Courses of ILR were monthly repeated until response or in cases of relapse. The primary outcome measure of the study was the rate of remissions (complete and partial remissions).
RESULTS
Twelve patients with PCMZL have been treated so far, 50% as first-line. The relapsed-group had previously received a median of 3 previous treatments (range, 1-6) including radiotherapy in 5 cases, surgery in 1 case, intravenous chemotherapy in 2 cases, and topic steroids in 2 cases. Clinical characteristics of the 12 patients are shown in the table below.
A total of 42 courses of ILR have been completed. All patients responded: a complete therapeutic response was achieved in 10 patients, whereas a partial response was observed in 2. No cases of progression or relapse in the site of ILR treatment were documented.
Four patients experienced transitory mild perilesional erythema that did not require medication and resolved in less than 4 hours. No cases of significant adverse events occurred and none of the patients suffered severe bacterial or opportunistic infections.
CONCLUSIONS
In our preliminary experience, ILR is an effective and safe therapeutic approach for selected PCMZL patients with single facial lesion, multifocal disease than cannot be irradiated, or in relapsed cases. To date, this is the largest experience with ILR of a single center.
Gonzalez Barca:Roche: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Speakers Bureau.
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