ABSTRACT

A 44-year-old man who presented lymphadenopathy was diagnosed with follicular lymphoma (FL). He was treated with rituximab, cyclophosphamide (CPM), doxorubicin, vincristine, and prednisolone (PSL), which resulted in a stable disease. The patient’s subsequent clinical course included partial remission and stable disease, each of which was treated by chemotherapy. At the third regrowth of the tumor, however, the patient was diagnosed with leukocytopenia and could not undergo further chemotherapy. Regression of his lymphadenopathy occurred following treatment with clarithromycin (CAM), which has anti-lymphoproliferative effects. CAM was continued with good outcome and then CAM was tentatively discontinued. Invasion of the lymphoma cells into the thoracic vertebrae occurred and was successfully treated by radiotherapy. Thereafter, he was successfully treated with CAM combined with PSL and CPM. At 57 years of age, he developed pancytopenia owing to therapy-related myelodysplastic syndrome; consequently, CPM was discontinued. Treatment with CAM combined with PSL was continued successfully. However, 15 months later, he complained of exophthalmos. Magnetic resonance imaging revealed a right orbital lesion. As an alternative to CAM combined with PSL, treatment with intravenous EM combined with PSL was used successfully. This case shows that treatment with intravenous EM combined with PSL may be effective in some cases of refractory FL.