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Lenalidomide, celecoxib, and azacitidine therapy for blastic plasmocytoid dendritic cell neoplasm: a case report

Authors Garcia-Recio M, Martinez-Serra J, Bento L, Ramos R, Gines J, Daumal J, Sampol A, Gutierrez A

Received 6 March 2016

Accepted for publication 6 July 2016

Published 7 September 2016 Volume 2016:9 Pages 5507—5511


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Min Li

Marta Garcia-Recio,1,2 Jordi Martinez-Serra,1,2 Leyre Bento,1,2 Rafael Ramos,2,3 Jordi Gines,4 Jaime Daumal,5 Antonia Sampol,1,2 Antonio Gutierrez1,2

1Service of Hematology, 2Instituto de Investigación Sanitaria de Palma (IdISPa), 3Service of Pathology, 4Pharmacy Department, 5Service of Nuclear Medicine, Son Espases University Hospital, Palma de Mallorca, Spain

Abstract: Blastic plasmocytoid dendritic cell neoplasm is characterized by aggressive behavior with a tendency for systemic dissemination and a predilection for skin, lymph nodes, soft tissues, peripheral blood, or bone marrow. It usually occurs in elderly patients with a mean age between 60 and 70 years. Despite initial response to chemotherapy, the disease regularly relapses with a short median overall survival. Better outcomes have been reported with high-dose acute leukemia-like induction chemotherapy followed by consolidation with allogeneic hematopoietic stem cell transplantation. However, elderly patients are not candidates for intensive therapy or allogeneic stem cell transplantation. So, new active and tolerable drugs are needed. Our case illustrates that one cycle of lenalidomide and celecoxib provides at least a partial cutaneous and hematologic response, but this regimen was discontinued due to toxicity and followed by a consolidation/maintenance phase with azacitidine, thus achieving a final complete response with a much higher than expected progression-free and overall survival in an elderly patient with comorbidities. This information may be useful in the design of treatment approaches for elderly patients with blastic plasmocytoid dendritic cell neoplasm. However, it should be confirmed in clinical trials as well as by optimizing the induction and extending the consolidation/maintenance period to avoid early relapses after discontinuation and improve progression-free survival.

Keywords: blastic plasmocytoid dendritic cell neoplasm, elderly, immunomodulatory, COX-2, hypomethylating

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