Yttrium-90 Microsphere Radioembolization of the Spleen: A New Approach for the Treatment of Malignant Lymphomatous Splenomegaly

To our knowledge, radioembolization with 90Y-labeled microspheres has never been reported for lymphomatous diseases. A 77-year-old man with marginal zone lymphoma with symptomatic splenomegaly (SM) was treated with 3700 MBb. This procedure is safe and effective and deserves further investigation in lymphomatous or other malignant SM.

Full Abstract

Introduction

90Y-labeled microsphere (90YRE) is used for the locoregional treatment of hepatic neoplasia. To the best of our knowledge, it has never been reported as a therapeutic approach for lymphomatous diseases.

Patients and Methods

A 77-year-old man with marginal zone lymphoma CD20⁺ and CD5, CD10, CD23⁻ developed a lymphomatous leukemia with symptomatic splenomegaly (SM). After several lines of chemotherapies, he progressed into an aggressive clinical disease with a major enlargement of his spleen responsible for hyperleukocytosis above 200000/μL, anemia requiring regular transfusions, abdominal pain, and anorexia. Palliative irradiation of the spleen with 16 Gy allowed an ephemeral hematologic stabilization. In order to reduce the splenic volume, we performed 90YRE. 3700 MBb of 90Y-labelled microspheres (SIRTEX®) was selectively administered via the splenic artery, which corresponds to a total dose of 36 Gy (calculated from treatment simulation/dosimetry with Technetium-99m—labeled macro-aggregates of albumin). This unusual procedure was safe and led to complete normalization of the blood cell counts.

Discussion

Radioembolization is a well-known safe procedure for hepatic neoplasia. A similar procedure has been previously reported years ago with a successful outcome for congestive hypersplenism due to idiopathic cirrhosis. Radioembolization by classical approach and splenectomy is usually complicated by severe morbidity. Irradiation could injure adjacent organs. In our patient, 90YRE was well tolerated with reduction of splenic volume. Despite major medullar infiltration with circulating leukemic cells, the complete normalization of the BCC suggests a major role of the irradiation of lymphomatous cells stored or circulating through the spleen. The response duration was 3 months, and the treatment has recently been repeated.

Conclusion

This case report suggests that 90YRE is a safe and effective procedure that deserves further investigation in lymphomatous or other malignant SM. Indeed, this procedure was better tolerated than classical embolization, with impressive results in this highly refractory patient.