melphalan and Celiac-Disease

Enteropathy-associated T cell lymphoma (EATL) is a rare entity associated with coeliac disease, with a poor prognosis due to perforation and gastro-intestinal bleeding during treatment, and a high relapse risk. Six patients were treated with two cycles of IVE (ifosphamide, etoposide, epirubicin), followed by two cycles of high-dose methotrexate (3 g/m(2)) with folinic acid rescue and a BEAM (carmustine, etoposide, cytarabine, melphalan) autograft. Enteral feeding was given throughout treatment. Four patients remain alive in complete remission at 1.83-4.32 years; two have relapsed. Given the historically poor outcome in these patients, this regimen appears very promising in the treatment of EATL.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Celiac Disease; Combined Modality Therapy; Cytarabine; Enteral Nutrition; Epirubicin; Etoposide; Female; Granulocyte Colony-Stimulating Factor; Humans; Ifosfamide; Immunosuppressive Agents; Lymphoma, T-Cell, Peripheral; Male; Melphalan; Methotrexate; Middle Aged; Peripheral Blood Stem Cell Transplantation; Podophyllotoxin; Transplantation Conditioning; Transplantation, Autologous; Treatment Outcome

A patient with malabsorption syndrome and steatorrhea was found to have IgG (lambda) M component in the blood and some extracellular deposition of IgG in the intestinal wall. There was no evidence of multiple myeloma. He responded favourably to intermittent courses of melphalan and prednisone.

Topics: Celiac Disease; Humans; Immunoglobulin lambda-Chains; Immunoglobulin Light Chains; Intestine, Small; Malabsorption Syndromes; Male; Melphalan; Middle Aged; Prednisone