Nodal Anaplastic Large-Cell Lymphoma ALK-1− with CD30+ Cutaneous Lymphoproliferation Treated with Mistletoe: Spontaneous Remission or Treatment Response?

Abstract

A 12-year old girl presented with general weakness and weight loss, a localised cervical lymph node enlargement and cutaneous lesions compatible with lymphomatoid papulosis (LyP). Biopsies from lymph node and skin revealed a histological diagnosis of nodal large cell ALK-1− anaplastic lymphoma (ALCL) with a synchronous CD30+ cutaneous lymphoproliferation consistent with lymphomatoid papulosis (LyP). The girl was treated with mistletoe (MT) as monotherapy. Within 1 week after initiation of MT-treatment the skin lesions and lymph node enlargement improved. Under continuing MT-therapy 30 months after diagnosis the patient is still in complete remission. It is not possible to know whether this was a rare case of spontaneous remission of the nodal and skin-manifestations of this CD30+ T-cell lymphoproliferation or whether the observed effect was a specific therapeutic response to MT-treatment.

Zusammenfassung

Ein 12-jähriges Mädchen stellte sich mit Abgeschlagenheit und Gewichtsverlust, einer lokalisierten Lymphknotenschwellung und Hauteffloreszenzen, vereinbar mit einer lymphomatoiden Papulose (LyP) vor. Die Biopsien des Lymphknotens und der Haut erbrachten die histologische Diagnose des Lymphknotens eines großzellig anaplastischen ALK-1− negativen Lymphoms (ALCL), mit gleichzeitiger CD30+ kutanen Lymphoproliferation, die mit einer lymphomatoiden Papulose vereinbar war. Das Mädchen wurde mit Misteltherapie (MT) als Monotherapie behandelt. Innerhalb einer Woche nach Beginn der MT-Therapie kam es zur Besserung der Hauteffloreszenen und der Lymphknotenvergrößerung. Unter MT ist die Patientin weiterhin 30 Monate nach Diagnosestellung in kompletter Remission. Abschließend ist es nicht möglich zu beurteilen, ob dies ein seltener Fall einer Spontanremission einer Lymphknoten- und Hautmanifestation einer CD30+ T-Zell-Lymphoproliferation war oder ob der beobachtete Effekt ein spezifisches Therapieansprechen auf eine MT-Therapie war.

Key words

lymphomatoid papulosis - primary cutaneous CD30+ T-cell lymphoproliferation - mistletoe - complementary and alternativ medicine

Schlüsselwörter

lymphomatoide Papulose - primäre kutane CD30+ T-Zell-Lymphoproliferation - Mistel - komplementäre und alternative Therapie

• References

• 1 Bekkenk MW, Francoise AM, Gellen G et al. Primary and secondary cutaneous CD30+ lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment. Blood 2000; 95: 3653-3661
• 2 Brockmeyer B, Schulte JH, Oberthuer A et al. ALK Mutation analysis in patients of the German neuroblastoma study. Klin Padiatr 2009; 221: 195
• 3 Büssing A. Biological and pharmacological properties of Viscum album L. From tissue flask to man. In: Büssing A. Medicinal an Aromatic plants- Industrial Profiles. Mistletoe The Genus Visum. Arwood Academic. Publishers; Amsterdam: 2000: 123-182
• 4 Debatin KM. Growth control of normal and malignant lymphocytes- cell death research from basic concepts to signal pathways and translation into the clinic. Klin Padiatr 2009; 221: 332-338
• 5 Fulda S. Cell death and survival signalling in oncogenesis. Klin Padiatr 2009; 222: 340-344
• 6 Kadin ME, Levi E, Kempf W. Progression of lymphomatoid papulosis to systemic lymphoma is associated with escape from growth inhibition by transforming growth factor-beta and CD30 ligand. Ann N Y Acad Sci 2001; 941: 59-68
• 7 Macaulay WL. Lymphomatoidpapulosis: a continuing self-healing eruption, clinically benign–histologically malignant. Arch Dermatol 1968; 97: 23-31
• 8 Mori M, Manuelli C, Pimpinell L et al. CD30-CD30 ligand interaction in primary cutaneous CD30+ T-cell lymphomas: a clue to the pathophysiology of clinical regression. Blood 1999; 94: 3077-3083
• 9 Nijsten T, Curiel-Lewandrowski C, Kadin ME. Lymphomatoid papulosis in children. Arch Dermatol 2004; 140: 306-312
• 10 Seifert G, Tautz C, Seeger K et al. Therapeutic use of mistletoe for CD30+ cutaneous lymphoproliferative disorder/lymphomatoid papulosis. J Eur Acad Dermatol Venereol 2007; 21 () 558-560
• 11 Seifert S, Jesse P, Laengler A et al. Molecular mechanisms of mistletoe plant extract-induced apoptosis in acute lymphoblastic leukemia in vivo and in vitro. Cancer Lett 2008; 18: 218-228
• 12 Swerdlow SH, Campo E, Harris N et al. WHO Classification of tumors of the haematopoietic and lymphoid tissues. Lyon: IARC; 2008
• 13 Zirbel GM, Gellis SE, Kadin ME et al. Lymphomatoid papulosis in children. J Am Acad Dermatol 1995; 33: 741-748