Primary cutaneous large B-cell lymphoma of the legs - A distinct clinical pathologic entity treated with CD20 monoclonal antibody (Rituximab)

Primary cutaneous large B-cell lymphoma of the legs (PCLBLL) is most common ly diagnosed in the elderly, and is generally confined to the lower parts o f one or sometimes both legs. Despite treatment with radiotherapy, relapses and extracutaneous involvement can occur, and unlike other low-grade cutan eous-B-cell non-Hodgkin's lymphomas (NHLs), the prognosis is variable, with an estimated 5-year survival rate of 58%. This report describes the case o f an 81-year-old man who was diagnosed with PCLBLL. Staging evaluation did not reveal NHL elsewhere. The patient declined recommendations to receive c ytotoxic chemotherapy. Instead, he was treated with anti-CD20 monoclonal th erapy (rituximab) and his cutaneous lesions completely regressed during a 1 6-week period. This report suggests that rituximab is a therapeutic option for those patients with PCLBLL who may not be good candidates to receive ra diation therapy or chemotherapy. Long-term follow-up and greater experience with rituximab in a variety of clinical settings will ultimately determine the appropriate role of this costly, but relatively safe, antibody-based t herapy for CD20+ expressing NHLs.