YO14 - Utility & Efficacy of Thymosin Alpha in A Case of Non-Hodgkin T Cell Lymphoma Initially Diagnosed as Hemophagocytic Lymphohistiocytosis
|Date||18 December 2016|
|Event||ESMO Asia 2016 Congress|
|Presenter||Herdee Gloriane Luna|
H.G. Luna, G. Cristal-Luna
G.E., a 67 year old male, Hypertensive, with 4 month history of progressive body weakness (ECOG 3) came in for second opinion. Work-ups from previous hospital, 4 months prior to consult, showed CT Scan with numerous enlarged and confluent lymph nodes in the cervical, mediastinal, bilateral axillary areas (largest measuring 3.5 x 3.8 x 3.6 cm); mesenteric, aorto-caval and inguinal regions, the largest in these regions measure 1.1 cm, 1.3 cm and 1.6 cm, respectively; subcentimeter noncalcified nodules in the right middle lobe; minimal fibrotic densities in the left apex; subpleural bleb in the right upper lobe; bilateral pleural effusion (more on the left), & suspicious enhancing nodule in hepatic segment 8. Patient underwent left axillary mass biopsy done 2 months prior to consult, which revealed reactive cells. Left cervical lymph node biopsy done 1 month prior to consult demonstrated atypical lymphoid proliferation. BMA showed normocellular bone marrow with trilineage hematopoiesis. Serum LDH was at 210 U/L and Uric Acid at 2.95 mg/dL. Patient was admitted at our institution due to progressive body weakness & work-up. Second set of slide review of the left cervical lymph node biopsy done in our center revealed Hemophagocytic Lymphohistiocytosis (HLH). Immunodeficiency panel revealed decreased Total lymphocyte populations. Patient was started with Thymosin Alpha 1.6mg SC daily and Dexamethasone 4mg IV Q6 day1-5 every week. Patient was sent home after 2 weeks with marked clinical improvement (ECOG 0). He was maintained for two months with Thymosin Alpha 1.6mg SC once a day for 4 consecutive days weekly and Dexamethasone 4mg BID PO on Days 1-5 for 2 weeks every 21 days. Third set of slide review of the left cervical lymph node biopsy was consistent with Non-Hodgkin T Cell Lymphoma (IHC CD2+, CD4+, CD8+, CD10 equivocal, CD7+, BCL2+). After 2 months of non-chemotherapeutic treatment, patient was evaluated with PET CT Scan revealing no evidence of hypermetabolic active lymphomatous disease, small pulmonary nodules too small for PET characterization & enhancing liver nodule. Patient was then advised to continue Thymosin Alpha 1.6mg SC 1x a day, 4 days in a week.