Combined systemic and ocular chemotherapy for anterior segment metastasis of systemic mantle cell lymphoma

Aniruddha Agarwal, Mohammad Ali Sadiq, William R. Rhoades, Loren S. Jack, Mostafa Hanout, Philip Jay Bierman, William W. West, Quan Dong Nguyen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Mantle cell lymphoma (MCL) is an aggressive subtype of non-Hodgkin’s lymphoma that rarely metastasizes to the iris and the anterior segment. Blastic/pleomorphic morphology is thought to have an adverse effect on prognosis in MCL. MCL is resistant to conventional chemotherapeutic regimens with a tendency for multiple relapses. Management of anterior segment metastasis of systemic MCL has not been described in literature. Findings: A 58-year-old male presented with an aggressive, relapsing, metastatic, systemic blastic variant of MCL with ocular involvement. At the time of initial presentation, large tumor cells were visible in the anterior chamber (AC) along with hypopyon and fibrin. The AC cells stained positively for CD20. The iris was thickened and coated with lymphoma cells. Iris neovascularization was present. Given extensive systemic and ocular involvement, the patient was given combination chemotherapy with systemic ibrutinib and intravitreal injections of methotrexate and rituximab. The disease response was monitored using multimodal imaging, including anterior segment optical coherence tomography and ultrasound biomicroscopy. Following combination of systemic and intraocular chemotherapy, there was a marked decrease in the ocular tumor load and the systemic disease. Conclusions: Combination therapy with intravitreal injections of chemotherapeutic agents targeting monoclonal B-cell population and novel systemic agents may help to achieve remission in anterior segment metastasis of aggressive subtypes of NHL such as blastic variant of MCL. Multimodal imaging may assist in the management of these cases.

Original languageEnglish (US)
Article number30
JournalJournal of Ophthalmic Inflammation and Infection
Volume5
Issue number1
DOIs
StatePublished - Dec 1 2015

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Mantle-Cell Lymphoma
Neoplasm Metastasis
Drug Therapy
Iris
Multimodal Imaging
Intravitreal Injections
Anterior Chamber
Acoustic Microscopy
Optical Coherence Tomography
Case Management
Combination Drug Therapy
Tumor Burden
Fibrin
Methotrexate
Non-Hodgkin's Lymphoma
Lymphoma
B-Lymphocytes
Recurrence
Population
Neoplasms

Keywords

  • Ibrutinib
  • Iris
  • Mantle cell lymphoma
  • Metastasis
  • Methotrexate
  • Rituximab
  • Ultrasound biomicroscopy
  • Uveitis

ASJC Scopus subject areas

  • Ophthalmology
  • Infectious Diseases

Cite this

Combined systemic and ocular chemotherapy for anterior segment metastasis of systemic mantle cell lymphoma. / Agarwal, Aniruddha; Sadiq, Mohammad Ali; Rhoades, William R.; Jack, Loren S.; Hanout, Mostafa; Bierman, Philip Jay; West, William W.; Nguyen, Quan Dong.

In: Journal of Ophthalmic Inflammation and Infection, Vol. 5, No. 1, 30, 01.12.2015.

Research output: Contribution to journalArticle

Agarwal, Aniruddha ; Sadiq, Mohammad Ali ; Rhoades, William R. ; Jack, Loren S. ; Hanout, Mostafa ; Bierman, Philip Jay ; West, William W. ; Nguyen, Quan Dong. / Combined systemic and ocular chemotherapy for anterior segment metastasis of systemic mantle cell lymphoma. In: Journal of Ophthalmic Inflammation and Infection. 2015 ; Vol. 5, No. 1.
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AB - Background: Mantle cell lymphoma (MCL) is an aggressive subtype of non-Hodgkin’s lymphoma that rarely metastasizes to the iris and the anterior segment. Blastic/pleomorphic morphology is thought to have an adverse effect on prognosis in MCL. MCL is resistant to conventional chemotherapeutic regimens with a tendency for multiple relapses. Management of anterior segment metastasis of systemic MCL has not been described in literature. Findings: A 58-year-old male presented with an aggressive, relapsing, metastatic, systemic blastic variant of MCL with ocular involvement. At the time of initial presentation, large tumor cells were visible in the anterior chamber (AC) along with hypopyon and fibrin. The AC cells stained positively for CD20. The iris was thickened and coated with lymphoma cells. Iris neovascularization was present. Given extensive systemic and ocular involvement, the patient was given combination chemotherapy with systemic ibrutinib and intravitreal injections of methotrexate and rituximab. The disease response was monitored using multimodal imaging, including anterior segment optical coherence tomography and ultrasound biomicroscopy. Following combination of systemic and intraocular chemotherapy, there was a marked decrease in the ocular tumor load and the systemic disease. Conclusions: Combination therapy with intravitreal injections of chemotherapeutic agents targeting monoclonal B-cell population and novel systemic agents may help to achieve remission in anterior segment metastasis of aggressive subtypes of NHL such as blastic variant of MCL. Multimodal imaging may assist in the management of these cases.

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