PLEOMORPHIC T-CELL LYMPHOMA - DIAGNOSTIC PROBLEMS, THERAPEUTIC APPROACHES AND INFECTIVE COMPLICATIONS

A 30-year-old man complained of high fever, resistant to antibiotics, and progressive loss of strength for five weeks. The peripheral blood showed pancytopenia (leucocytes 2200/mul, platelets 45,000/mul, haemog lobin 10.7 g/dl). There was also hepatosplenomegaly, abdominal lymph n ode enlargement, pleural and pericardial effusions and slight excess o f lymphocytes in the cerebrospinal fluid. Histological examination of the bone marrow suggested a small-cell pleomorphic T-cell lymphoma, bu t Hodgkin's disease was also considered. Splenectomy was performed to confirm the diagnosis and treat the pancytopenia. The blood count rapi dly returned to normal and the suggestion of Hodgkin's disease was exc luded. Intensive chemotherapy (BMFT-ALL protocol) was followed by regr ession of nearly all the abnormalities, but marrow infiltration persis ted. This treatment was discontinued after phase 11 of induction. Afte r an intercurrent cytomegalovirus infection maintenance treatment with alpha-interferon (up to 5 million units daily) was started. The parti al remission remained stable for 22 months. The lymphoma then relapsed but was held in check by further chemotherapy (Dexa-PAMB protocol). F or the past 11 months the patient has remained in stable partial remis sion on treatment with alpha-interferon (3 million units every other d ay). Frequent infections (sinusitis, diarrhoea, abscess) require close supervision.