Onkológia 5/2024

An unusual presentation of relapse of a pediatric oncological disease

Introduction: We present a case of an unusual presentation of relapse in B-cell lymphoma. Case report: The patient was treated at the age of 17 for primary mediastinal large B-cell lymphoma (PMBCL) and achieved complete remission. Several months after completing therapy, the patient was hospitalized due to recurrent epileptic seizures. Magnetic resonance imaging (MRI) of the brain revealed an enhancing focal expansion of the CNS in the right parietal parasagittal region, which was further investigated after a biopsy (complicated by an unfruitful procedure due to unfavorable localization) and PET/MRI, confirming an early relapse of lymphoma with histology corresponding to the primary diagnosis. The patient responded well to relapse therapy combining chemotherapy and molecular targeted treatment, followed by radiotherapy, achieving a second remission. This was followed by maintenance including taxanes and immunotherapy. As of the time of writing, the second remission has lasted one year after the completion of therapy. Conclusion: Oncological diseases in children are rare, and their presentation can mimic other conditions. Early diagnosis of relapse is a fundamental prerequisite for effective therapy. The relapsed patient was treated with personalized biomarker-based approach, and the duration of the second event-free survival (EFS) is significantly longer than the initial one. The treatment outcomes support the use of a non-transplant biomarker-based approach for patients with limited treatment options like relapsed NHL.

Keywords: primary mediastinal large B-cell lymphoma, personalized treatment, relapse, pediatric onkology