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A 73-year-old female with malaise, anorexia, and hydrodipsia was referred to our department. Peripheral blood tests revealed leukocytosis with 51% blast cells exhibiting flower-shaped nuclei. Flow-cytometry to detect tumor cells in peripheral blood indicated CD3+, CD4+, CD8-, and CD25- expression, but those in the lymph nodes expressed CD25+. Southern blots revealed clonal HTLV-1 provirus in the tumor cells, consistent with adult T-cell leukemia-lymphoma. Cytotoxic chemotherapy was ineffective, but eight cycles of mogamulizumab induced complete remission (CR). A relapse lesion appeared on the right breast but disappeared spontaneously. The patient has currently maintained CR for over five years.

Background The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Although several researchers have reported the effectiveness of comprehensive geriatric assessment (CGA) and the futility of curative treatment in ‘unfit’ patients with DLBCL, these propositions are not firmly established. Patients and methods We conducted a retrospective analysis using a database. Patients with DLBCL were eligible if ≧ 60 yr old. CGA stratification was performed using medical records. Results One hundred and 35 patients were identified. Anthracycline-based chemotherapy with curative intent was performed in 115 (85%) patients. According to CGA, 82 (61%) patients were classified as ‘fit’. Their 1-yr overall survival (OS) was significantly better than that of ‘unfit’ patients [91.3% vs. 53.8%, P

Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma, and it is characterized by diffuse cerebral infiltration of malignant lymphoma cells without evidence of a mass lesion. Herein, we report a patient with systemic peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) who had central nervous system involvement mimicking LC. A 72-year-old immunocompetent male presented with rapidly progressive dementia. Fluor-deoxy-glucose (FDG) -positron emission tomography revealed increased FDG uptake in the bone and skin. Histopathological examination of the skin lesion revealed PTCL-NOS infiltration. A FLAIR MRI scan of the brain revealed diffuse hyperintense lesions in the cerebral white matter of both hemispheres. These lesions were not enhanced with gadolinium, and there was no perceptible mass effect. We performed a brain biopsy, and the histology results were consistent with PTCL-NOS. The patient was treated with corticosteroid and chemotherapy; however the disease progressed, and he died 4 months after the diagnosis. This was a rare case of systemic lymphoma accompanied with central nervous system involvement mimicking LC.

Double-hit lymphomas are rare tumors that are defined by a chromosomal breakpoint affecting the MYC/8q24 locus in combination with another recurrent breakpoint, mainly a t(14; 18)(q32;q21)involving BCL2. We report a case of a 38-yearold woman with a 2-month history of abdominaldistention. 18F-FDG PET showed multiple positive systemic lymph nodes, positive peritoneum, and multiple positive intra-abdominal masses. Histopathology results of the cervical lymph node were compatible with double-hit follicular lymphoma(Grade 3A)because fluorescence in situ hybridization(FISH)demonstrated both MYC rearrangement and BCL2 gene fusion. She was initially started on R-CHOP(rituximab and doxorubicin, vincristine, cyclophosphamide, and prednisolone), but after one course the regimen was changed to dose-adjusted EPOCH-R(rituximab and doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisolone). However, she showed no response to this chemotherapy regimen or haploidentical stem cell transplantation. The treatment strategy included salvage chemothera- py. An autologous and/or allogeneic hematopoietic transplantation is important for non-responders to DA-EPOCH-R.

A 77-year-old-man was diagnosed with follicular lymphoma (FL), grade 3A. After six courses of R-THP-COP (rituximab, pirarubicin, cyclophosphamide, vincristine and prednisolone) therapy, he achieved complete remission (CR). He achieved a second CR after radiotherapy, a third CR after six courses of bendamustine /rituximab (BR) therapy, and a fourth CR after six courses of BR therapy. However 2 months after the last chemotherapy, his tumor progressed rapidly and he died. Autopsy results showed medium and large lymphoid cells with pleomorphic, irregular nuclei and prominent nucleoli infiltrated in multiple lymph nodes, the liver, the lung, and the spleen. The lymphoid cells were positive for CD3, CD8, granzymeB, TIA-1 and negative for CD4, CD20, CD79a, CD10, and CD56. Autopsy diagnosis was peripheral T-cell lymphoma, not otherwise specified. Occurrence of lymphoma in T-cell lineage should be considered, if the course of low-grade B-cell lymphomas, such as FL rapidly progresses.

Cutaneous extramedullary hematopoiesis has been reported in a small number of patients with myelofibrosis. A 79-year-old male with JAK2V617F-positive myelodysplastic/myeloproliferative neoplasm, unclassifiable (MDS-MPN-U), presented with multiple skin lesions. The skin lesions were papulonodular, reddish brown, and elastic hard on palpation. Based on a lesion biopsy, cutaneous extramedullary hematopoiesis associated with MDS/MPN-U was diagnosed. He died four months later due to exacerbation of MDS/MPN-U. Cutaneous invasion might be associated with progressive disease and a poor prognosis for MDS/MPN-U, as it is for myelofibrosis.

Patients with hyperleucocytic leukemia (WBC count10×10(4) mL) are at high risk of early mortality owing to pulmonary or cerebral leukostasis. Several researchers have reported the efficacy of immediate leukapheresis. Here, we report of a patient with chronic myelogenous leukemia in blast crisis and with pulmonary failure due to leukostasis who recovered after a combination therapy of leukapheresis and imatinib treatment.

A 77-year-old man was diagnosed with cold agglutinin disease in 2004. He had been treated with prednisolone with stabilization of hemoglobin in the 6- to 8-g/dl range. However, his hemolytic anemia worsened, and computed tomography showed systemic lymphadenopathy in May 2012. A pathological diagnosis of small lymphocytic lymphoma was made based on an inguinal lymph node biopsy. Treatment was started with rituximab. However, there was no response to 6 doses of rituximab monotherapy. He next received 6 courses of bendamustine in combination with rituximab. This resulted in stabilization of hemoglobin and independence from transfusion support. To the best of our knowledge, this is only the second case report describing bendamustine plus rituximab treatment for non-Hodgkin lymphoma complicated by cold agglutinin disease. Our results in this case suggest bendamustine to potentially be a useful therapeutic option in patients with cold agglutinin disease.

Introduction: The treatment strategy for diffuse large B-cell lymphoma (DLBCL) in elderly patients is problematic. Recently, the Comprehensive Geriatric Assessment (CGA) has been proposed as an objective tool to identify those who can safely tolerate curative treatment. Although several researchers have reported the effectiveness of CGA in patients with aggressive B-cell non-Hodgkin lymphoma and revealed that intensive treatment cannot improve the outcomes of patients identified by CGA as unfit, compared with palliative treatment, the effectiveness of CGA and the effects of treatment are not firmly established. In the present study of elderly patients, we evaluated clinical outcomes and the prognostic value of clinical and biological parameters, including CGA stratification and treatment. Methods: We conducted a retrospective analysis using a database at our hospital. Patients were eligible if aged 60 years or older and diagnosed with DLBCL between November 1, 2000 and August 31, 2013. CGA stratification was performed using medical records, including assessment of the following four parameters: 1) age >= 80 years; 2) ADL including bathing, dressing, toileting, transferring, feeding, and continence; 3) comorbidity score according to the Cumulative Illness Rating Score for Geriatrics (CIRS-G) and evaluated for all organs/systems as follows: no problem – 1, mild problem – 2, moderate disabilities or morbidities (requiring treatment) – 3, severe and significant chronic disabilities – 4, and extremely severe disabilities – 5 ; and 4) geriatric syndrome, defined as the occurrence of dementia, delirium, depression, incontinence, falls, osteoporosis, neglect and abuse, or failure to thrive. Patients were classified as "fit" if they were aged We classified treatment as CHOP+-R, THP-COP+-R (THP-COP: pirarubicin 30 mg/m2, cyclophosphamide 500 mg/m2 and vincristine 1 mg/m2 on day 1 and predonisolone 30 mg/day on days 1–5), surgery alone, and palliative therapy (radiation, low-dose chemotherapy, rituximab alone, and corticosteroids). We compared overall survival (OS), progression free survival (PFS), complete response rate (CRR) and overall response rate (ORR) with each CGA stratification and treatment. Results: 87 patients were identified, with a median age of 72 years (range 60–84), 59% >= 70 years, and 16% >= 80 years; 53% male; 67% Stage III/IV; 62% IPI high–int/high, 20% loss of ADL and 13% geriatric syndrome. 70% were CGA fit and 30% unfit. 39% were treated with CHOP+-R, 53% THP-COP+-R, 2% surgery alone, 6% palliative therapy and 84% received rituximab. Median observation time was 859 days (range 40–4955). Univariate analysis showed the parameters negatively affecting OS were: loss of ADL (p At five years, the outcomes of the patients treated with CHOP+-R and THP-COP+-R were similar in terms of OS (85.0% vs 77.2%; p=0.95), see figure 1, PFS (56.4% vs 66.9%; p=0.96), CRR and ORR. The patients treated aggressively (CHOP or THP-COP +- R) had significantly better OS, PFS, CRR and ORR compared with those receiving palliation. We also observed better outcomes in terms of OS (p Conclusions: In this study, we observed similar outcomes regarding OS and PFS between two aggressive treatments (CHOP or THP-COP +- R). The patients treated aggressively had significantly better outcomes compared to those receiving palliation, irrespective of CGA stratification. Intensive treatment should be considered even for unfit patients. Disclosures No relevant conflicts of interest to declare.