Primary breast double-hit lymphoma is a very rare, highly aggressive malignancy that presents a great challenge regarding proper diagnosis and optimal treatment. Our case involved high-grade B-cell lymphoma with MYC and BCL2 rearrangement (double hit), treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin chemotherapy, resulting in complete resolution.
Given persistent cholestasis and bleeding risk, the patient underwent Roux-en-Y choledochojejunostomy for biliary decompression, followed by initiation of rituximab-cyclophosphamide-vincristine-doxorubicin-high-dose methotrexate/rituximab-ifosfamide-etoposide-high-dose cytarabine (R-CODOX-M/R-IVAC) with central nervous system prophylaxis...Ampullary BL should be considered in pediatric patients with obstructive jaundice and upper gastrointestinal bleeding. Surgical biliary decompression can stabilize cholestasis and facilitate timely multi-agent chemotherapy.
The patient was subsequently treated with DA-EPOCH chemotherapy (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), leading to significant regression of disease on interim PET scan. This case represents the 10th reported transformation of MM to PBL and highlights the diagnostic dilemma posed by these entities. It underscores the importance of clinical context, the potential for clonal evolution (evidenced by a light-chain switch), and the efficacy of lymphoma-specific chemotherapy in this setting.
P=N/A, N=100, Recruiting, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) | Trial completion date: May 2026 --> May 2027 | Trial primary completion date: May 2026 --> May 2027
3 days ago
Trial completion date • Trial primary completion date
P2, N=132, Not yet recruiting, Masonic Cancer Center, University of Minnesota
3 days ago
New P2 trial
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HLA-DRB1 (Major Histocompatibility Complex, Class II, DR Beta 1) • HLA-B (Major Histocompatibility Complex, Class I, B) • HLA-C (Major Histocompatibility Complex, Class I, C)
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cyclophosphamide • fludarabine IV • Grafapex (treosulfan)