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Treatment of Bing-Neel syndrome with first line sequential chemoimmunotherapy: A case report.

Authors
  • Gavriatopoulou, Maria1
  • Ntanasis-Stathopoulos, Ioannis1
  • Moulopoulos, Lia-Angela2
  • Manaios, Alexandros3
  • Fotiou, Despina1
  • Eleutherakis-Papaiakovou, Evangelos1
  • Migkou, Magdalini1
  • Bourgioti, Charis2
  • Terpos, Evangelos1
  • Kastritis, Efstathios1
  • Dimopoulos, Meletios-Athanasios1
  • 1 Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital.
  • 2 First Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Areteion Hospital.
  • 3 "Athens Vision" Ophthalmology Clinic, Athens, Greece. , (Greece)
Type
Published Article
Journal
Medicine
Publisher
Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins
Publication Date
Nov 01, 2019
Volume
98
Issue
44
Identifiers
DOI: 10.1097/MD.0000000000017794
PMID: 31689856
Source
Medline
Language
English
License
Unknown

Abstract

Bing-Neel syndrome (BNS) is a rare manifestation of Waldenström macroglobulinemia (WM) with <200 cases reported in the literature. Herein, we describe a case of newly diagnosed BNS treated with a novel therapeutic strategy. A 67-year-old woman diagnosed with asymptomatic WM 3 years ago presented with gradual vision deterioration the past 3 months. Ophthalmologic examination revealed bilateral reduction in visual acuity (7/10) and bilateral optic disc swelling which was more prominent in the left eye. Brain imaging revealed bilateral swelling of optic nerves extending from the retina to the optic chiasm and swelling of the left optic tract. Patchy enhancement of optic nerves was also shown upon intravenous contrast administration. Flow cytometry of the cerebrospinal fluid (CSF) revealed the presence of κ-light chain restricted, monoclonal B-lymphocytes. CSF protein electrophoresis showed a monoclonal band in the gamma region and immunofixation was positive for immunoglobulin M and kappa light chain. Thus, the diagnosis of BNS was established. The patient was initially treated with intrathecal methotrexate and systemic chemotherapy. Following 2 intrathecal methotrexate infusions, CSF flow cytometry did not detect any cells, whereas the patient reported improvement in visual acuity. Therefore, we opted to start maintenance treatment with IV rituximab and per os ibrutinib. Following 1 year posttreatment initiation, visual problems have resolved completely and the patient remains on hematologic and imaging complete response. We propose a novel sequential chemoimmunotherapy approach for BNS treatment aiming both at rapid disease control and deep and durable remission with minimization of induced toxicity.

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